Medicare Advantage

Medicare Part C is the combination of all the benefits you get from Part A (hospitals) and Part B (doctors and doctor’s services ) along with other cost-sharing features and offered by insurance companies.   These plans are called MA.  If you have a Plan C that includes prescription drug coverage it is called MAPD.  As with any drug plan you need to make sure that the drug formulary contains the prescriptions you are taking.

There are various terms you would notice that are associated with MA and MAPD plans:   HMO, PPO, PFFS, RPPO are just a few.  Sometimes basic dental, vision or hearing are included in the plan. These types of plans work like Original Medicare.  When you have a plan like this you would show your doctor the Plan’s insurance card and NOT your Medicare card.  You still play the Part B premium, which is usually paid through your Social Security check.

When you are comparing MA and MAPD plans you need to pay attention to many details.

  • Monthly premium
  • Annual maximum out of pocket costs
  • In-Network/ Out-of-Network charges
  • Hospital deductible
  • Co-pays for services
  • Drug coverage
  • Dental benefits
  • Vision benefits
  • Hearing benefits

Since different insurance companies offer these plans and each plan is different in design you will need to look closely at each of these sections to make sure you understand how the plan will pay your doctors when you seek medical treatment and how much you would be expected to pay.  This is a “pay as you go” plan.

Often times the dental will cover cleanings and x-rays but not treatment.  Vision may cover getting glasses or just eye exams.   Spend time looking over the different plans  before you sign-up for one since you will have to keep it for the whole year.

These plans are guaranteed issue so there are no health questions to answer.  Generally, the monthly cost is lower than a Medicare supplement since you are sharing in the cost for the services you receive.  Whether this is truly a cost saving plan for you would depend on the cost of a Medicare supplement and how often you seek medical treatment.

When Can I Sign-up For the MA or MAPD?

You can sign-up for a MA or MAPD plan when you first turn 65, and during the Annual Election Period from October 15- December 1.  If you change your mind about getting the MA or MAPD plan you can dis-enroll from January 1 – February 15 and get back into Original Medicare.

What if I don’t like the Medicare Advantage Plan, is it too late to look at a Medicare Supplement?

Under Medicare you have “Trial Rights.” You have the right to “try” a Medicare Advantage plan and still get the Medicare supplement guaranteed issue.  If you are 65,  sign-up for a Medicare Advantage plan and have been on it less than 1 year you can switch to a Medicare Supplement and get it  guaranteed issue.

If you have a Medicare supplement and switch to Medicare Select or Medicare Advantage plan and in the first year decide you want to change back to the supplement you can do that also guaranteed issue.  You can go back to the Medicare supplement plan you had originally before you made the switch- and you can do this guaranteed issue.  You only have 1 year to try Medicare Advantage to make use the “Trial Right.”

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