Medicare Advantage: Private Health Insurance Through Medicare

Medicare Advantage plans (''Part C'') are required to cover the same services that Original Medicare covers. Some may also cover prescription drugs and dental or vision care.

Medicare Advantage plans may give you some discounts or pay for services that Original Medicare may not cover, like vision and dental care. However, Medicare Advantage plans are administered by private health insurers and you'll be required to follow your plan's rules. Original Medicare allows you to see just about any doctor and go to any hospital that accepts Medicare , which most providers accept. With Medicare Advantage plans, you're typically restricted to the doctors and hospitals included in the plan's network. You might need referrals to see a specialist.

So you have to look hard at what sort of medical coverage you need -- and what you can afford -- when deciding between Original Medicare and a Medicare Advantage plan.

To get a Medicare Advantage plan, you must already have Medicare Part A and Part B.

You will have many Medicare Advantage plans to choose from and the plans available vary from region to region. To learn what's available in your area, use the online Medicare Personal Plan Finder.

While most people won't need to pay a Part A premium, you will need to pay the "standard" Part B monthly premium, which is $135.50 in 2019. People with higher incomes (household income over $170,000) will pay higher premiums on a sliding scale, with adjustments ranging from about $54 to $325 more per month. The maximum premium will be $460.50.

On top of that, you may have to pay a monthly premium for your Medicare Advantage plan, though many plans come with no additional monthly cost at all. The price varies depending on your plan.

Here are other facts to consider before enrolling in a Medicare Advantage plan:

  • You may join a Medicare Advantage plan during your initial enrollment period, which spans the three months before and the three months after the month you turn 65.
  • After that, you may join, switch, or drop your coverage during the Annual Open Enrollment Period between Oct. 15 and Dec. 7, with coverage kicking in Jan. 1.
  • Beginning in 2019, there is an additional Medicare Advantage Open Enrollment period from Jan. 1 to March 31, when you can make changes to your coverage. During this time you can switch from one Medicare Advantage plan to another or disenroll from your Medicare Advantage plan and return to Original Medicare. You can only make one change during this period. If you are not already enrolled in a Medicare Advantage plan you cannot enroll during this period.
  • You may switch to a 5-star plan as rated by Medicare, (if there is one in your area) at any time during the year, though you can only make this switch once. If you switch from a Medicare Advantage plan that includes prescription drug coverage to a 5-star Medicare Advantage plan that does not, you will lose your drug coverage. You’ll have to wait until the next open enrollment period to select a Part D prescription drug plan and you may have to pay a late enrollment penalty.
  • If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of disability and ends 3 months after your 25th month of disability.
  • If you are in a Medicare Advantage plan, you cannot also sign up for a Medigap policy. That's because Medicare Advantage plans are intended to cover many of the same benefits that Medigap plans do. Keep in mind that if you have a Medigap policy and join a Medicare Advantage plan, you may lose the Medigap policy permanently.
  • If you're in a Medicare Advantage plan that offers prescription drug coverage, you cannot sign up for a separate Medicare Prescription Drug Plan.
  • Medicare Advantage plans must follow rules set by the federal government, but they can charge different amounts for co-payments and deductibles and have their own requirements, such as getting a referral from a primary care provider before you can see a specialist.
  • You may not be able to get a Medicare Advantage plan if you have end-stage kidney disease. However, you may qualify for a Medicare Special Needs Plan if one is available in your area. 

For more information about Medicare Advantage plans, see the Medicare web site or call 800-MEDICARE (1-800-633-4227).

WebMD Medical Reference Reviewed by Sarah Goodell on November 09, 2018

Sources

SOURCES:

Medicare.gov: ''Medicare & You 2016."

Center for Medicare Advocacy.

U.S. Department of Health and Human Services: ''Medicare Advantage remains strong.'' 

 

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