Medicare Advantage

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare to "replace" Parts A and B. If you join a Medicare Advantage Plan, you still have Medicare, but you will get the benefits which will replace Original Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).  Medicare Advantage Plans can also include Drug coverage and other "extra" benefits, i.e. transportation.

Medicare Advantage Plans Synopsis

Covered services in Medicare Advantage Plans

Medicare Advantage Plans cover all Medicare services. Medicare Advantage Plans may also offer extra coverage, like dental, hearing, vision and membership to health clubs. Some plans have the option of returning some of the monthly Part B premium.

Rules for Medicare Advantage Plans

The Center for Medicare and Medicare Services (CMS) pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs for services.  Fortunately out-of-pocket costs have an annual limit.  This is called the MOOP [Maximum Out Of Pocket].  , and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year. Veterans who have Tricare For Life can have even more benefits. They can have the best of both worlds. [Contact Me ]

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. If you want to know what your costs would be for a Medicare Advantage, select this button. [Contact Me ]

Drug coverage in Medicare Advantage Plans

It is customary to have prescription drug coverage (Part D) through your plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan. You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that does includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Reducing the cost of your Drugs

If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. In 2016, costs are no more than $2.95 for each generic $7.40 for each brand-name covered drug. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 

In 2016, you may qualify if you have up to $17,820 in yearly income ($24,030 for a married couple) and up to $13,640 in resources ($27,250 for a married couple).

If you don't qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans

Medigap policies can't work with Medicare Advantage Plans. Learn about your options related to Medigap policies and Medicare Advantage Plans. For more information regarding Medigap policies, please select. . [Contact Me ]

Reprinted in part from www.medicare.gov