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  • Writer's pictureCarole Meitler

Understanding Medicare Advantage

As you may recall from the previous articles in our Medicare series that there are two broad categories of Medicare: Original Medicare (Parts A, B, and D with the option of adding a Medigap policy) and Medicare Advantage plans, also referred to as Part C Medicare. In this final article on Medicare, we will look at Medicare Advantage, the “all in one” type alternative to Original Medicare.

Things to know about MA plans:

  • Medicare Advantage (MA) plans allow private insurance companies to offer package plans of Medicare benefits.

  • While enrolled in an MA plan, you are still in the Medicare program and have Part A (hospital insurance) and B (medical insurance), and usually Part D (drug coverage) Medicare coverage. However, you often have extra coverage like vision and dental, all packaged into the particular MA plan.

  • Most MA plans offer prescription drug coverage. The specific drugs covered can vary by plan. You can (and should) check to see if a particular plan covers the drugs you use.

  • MA has a yearly limit on out-of-pocket costs which may often make these plans a less costly option overall. Once you reach this limit, you will have no additional costs for medical providers and services used for the rest of the year. Each plan has a different limit, so be sure to look at that when you compare plan options.

  • You will need to go to a provider that belongs to your plan’s network. This applies to MA HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans. In addition, following the plan’s rules, like getting a referral to see a specialist, will keep your costs lower.

  • Providers can join or leave the plan’s network at any time during the year. If this happens, you may need to choose a new provider.

Questions to ask when looking for a plan:

  • What type of providers and services are covered in the plan and included in the plan network?

  • Are specific doctors, specialists, and services that I need and use included in the plan network?

  • Does the plan offer benefits that Original Medicare does not, like vision, dental, prescription drug coverage?

  • What is my share of the costs covered under the plan?

  • If you know anyone using some of the MA plan options, get their feedback on how easy it is to see the primary care doctor, to get needed referrals, to get quality care, etc. It is always helpful to get information from people using the particular plan if you can.

When can I join, discontinue, or change an MA plan?

You can join, drop, or change a Medicare health plan or MA plan during these time windows:

  • Initial enrollment: During the 7-month period that:

- Starts 3 months before the month you turn 65

- Includes the month you turn 65

- Ends 3 months after the month you turn 65

  • Medicare Open enrollment period: - Open enrollment is from October 15 – December 7 each year with any changes becoming effective January 1. During this time period you may join, drop, or change a plan.

  • Medicare Advantage open enrollment: - From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch from your MA plan to Original Medicare (and join a separate Medicare drug plan) once during this time.

How to compare and select an MA plan that is right for you:

You can find a great comparison tool by going here. This site will guide you through a short series of questions to give you options of MA plans and their various costs You may even put in the prescription drugs you use to be sure to find plans that cover those.

If you are making Medicare decisions and have any questions, please feel free to contact us. We are happy to help in any way we can.


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