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What is Medicare Advantage?

In a nutshell, Medicare Advantage (MA) plans (aka Medicare Part C), are required to offer everything that’s covered under Original Medicare (Parts A and B), except for hospice care, and may include other benefits too, like prescription drug coverage (Part D), dental, and vision. To join an MA plan, you must be enrolled in Original Medicare, which you will continue to benefit from. A plan cannot refuse your application based on your health needs, except in the case of an end-stage renal disease.

Plan availability depends on the county and state in which you live. MA Plans may have different networks of providers, coverage rules, premiums, and cost-sharing for covered services, so you should always check to find out how coverage works. Some of the most common types of MA Plans include Health Maintenance Organizations (HMOs), and Preferred Provider Organizations (PPOs). While HMOs typically require you to go to doctors or hospitals within your plan’s provider network, PPOs allow you to go out of network for higher copays.

Medicare Advantage is one way to receive Medicare benefits, but how do you know if it’s right for you?

The plus side

In addition to offering benefits beyond what Original Medicare offers, such as vision or dental coverage. Some insurance companies may offer a $0 premium for an MA plan, and each plan comes with a maximum out-of-pocket limit outlining how much you will spend on health costs each year. After your limit is reached, you pay no additional charges for covered services. Unsurprisingly, MA coverage significantly reduces the stress associated with medical coverage for many Americans.

The downside

It’s possible that your particular MA plan may require higher out-of-pocket costs than Original Medicare, and they can change their costs (premiums, deductibles, copays) every calendar year. As well, you may be required to follow strict guidelines (such as having to get referrals for specialists) in order to obtain coverage for specific services or products. You may also have to switch your doctor or hospital to one within your plan’s network or pay a higher cost. What’s more, MA plans have year-long contracts with Medicare and can opt not to renew for the following year, which could mean having to find a new plan.

To be sure you’re getting your best deal on a Medicare Advantage plan, compare plans in your area during the 2019 Open Enrollment period, which runs from November 1, 2018, to December 15, 2018, and if a change is called for, switch to another one for the following year.

For more information on Medicare Advantage plans covering your area, get in touch with the pros at at (877) 829-1109 today!