Medicare Advantage plans are an alternative to original Medicare. They’re offered by private companies Medicare pays to cover your benefits. Also called Part C or MA plans, they cover all the services you get with original Medicare. But some include extras like dental, vision, and hearing. In order to be eligible for a Medicare Advantage plan, you must be enrolled in both Part A and Part B. Here’s what you need to know.
What Does Medicare Advantage Cover?
Medicare Advantage plans include Part A (hospital insurance) and Part B (medical insurance), the same as original Medicare. But many also include Part D (drug coverage). If yours doesn’t, you can join a separate Medicare drug plan. Emergency and urgent care are always covered.
Some Medicare Advantage plans cover things original Medicare doesn’t. These include:
- Dental cleanings
- Vision checkups
- Hearing care
- Gym memberships
- Transportation to your doctor appointments
- Wellness programs
Medicare Advantage plans typically don’t cover medical care outside the U.S. Neither does original Medicare.
There are different types of Medicare Advantage plans. Each plan has its own rules about:
- What’s covered
- How you get services
- Your out-of-pocket costs
These rules can change each year. But they’ll let you know about any changes before the next year starts. Look out for an Annual Notice of Change document mailed to you by Sept. 30 and an Evidence of Coverage sent by Oct. 15.
What Doctors Can I See?
Where you can get care depends on what type of plan you have. With many Medicare Advantage plans, you can only use providers in the plan’s network and service area. Some plans cover out-of-network doctors at a higher cost. With original Medicare, you can go to any doctor or hospital that takes Medicare.
With a Medicare Advantage plan, you may need to get a referral from your primary care doctor to see a specialist. You don’t usually need this with original Medicare.
There are several types of Medicare Advantage plans:
Health maintenance organization (HMO) plans. You typically can only go to doctors, hospitals, and care providers in the plan’s network. Most HMOs require you to get a referral to see a specialist.
Preferred provider organization (PPO) plans. There’s a network of doctors, hospitals, and specialists you can use. You can also see other providers, usually for a higher cost. Make sure your plan covers specific services before getting them from an out-of-network provider. You can see a specialist without getting a referral.
Private fee-for-service (PFFS) plans. You can use any Medicare-approved doctor or hospital that accepts the plan’s payment terms. You won’t need a referral to see a specialist.
Special needs plans (SNPs). These plans are only available to people with specific diseases or needs. Some require you to use only in-network providers. Others cover out-of-network providers, usually for higher fees. You might need a referral for some services.
Medicare medical savings account (MSA) plans. These plans are similar to health savings account (HSA) plans you might have from an employer. They don’t usually have a network of doctors or hospitals, so you can get services from any Medicare provider. You won’t need a referral to see a specialist.
Depending on where you live, you may be able to choose from all of these plans, some, or none at all. Several plans of the same type may be available if private insurers offer them. Compare possible plans on Medicare.gov.
Can I Switch to Original Medicare?
If you’re not happy with Medicare Advantage, you can go back to original Medicare during certain enrollment periods:
Open enrollment period. From Oct. 16 to Dec. 7 every year, you can drop your Medicare Advantage Plan or switch to a different one.
Medicare Advantage open enrollment period. Between Jan. 1 and March 31, you can drop your Medicare Advantage plan and join original Medicare. You can join a Medicare drug plan at this point, too. Or you can switch to another Medicare Advantage plan.
Initial enrollment period. If you join a Medicare Advantage plan during your initial enrollment period (in other words, when you first become eligible for Medicare), you can go back to original Medicare or change to another Medicare Advantage plan during the first 3 months you have Medicare.
Before Joining a Medicare Advantage Plan
- Check to make sure your doctors are in the plan’s network.
- Find out if the plan covers your prescriptions.
- Confirm the costs, including premiums and deductibles.
- Make sure it includes the benefits you need.
Be careful if you have other insurance coverage through your employer or union. You could lose that coverage if you join a Medicare Advantage plan and may not be able to get it back. Check with your benefits administrator before joining a new plan.
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SOURCES:
Medicare.gov: “What’s a Medicare Advantage Plan?” “Medicare Advantage Plans Cover All Medicare Services,” “Understanding Medicare Advantage Plans,” “Your Health Plan Options,” “Get Started With Medicare.”
