Medicare Advantage
Medicare Part C, also known as Medicare Advantage, must cover all services that Original Medicare covers. Medicare Advantage can also provide additional coverage, such as:
- Prescription drugs
- Dental, vision, and hearing
- Wellness programs
- Fitness programs
- Nutrition programs
- Adult daycare
- Transportation for doctor visits
However, the benefits you receive will depend on your plan provider and the area you live in.
Types of Plans
Medicare Advantage has several plans to choose from:
- Health Maintenance Organization (HMO): HMO Plans will most likely ask you to choose a primary care physician within their network, as well as get referrals from your physician when you need to see a specialist. Despite this lack of flexibility, HMO Plans generally cost less than other Medicare Advantage Plans.
- Preferred Provider Organization (PPO): PPO Plans do not require you to select a primary care physician or get referrals to see specialists. You will usually have the option to receive your care outside of the plan’s network, though, but do note that you will pay more if you do so.
- Special Needs Plans (SNP): SNPs are limited to certain individuals with specific needs. The three types of SNPs include Chronic-Condition, Dual-Eligible, and Institutional Plans. Medicare requires these plans to provide prescription drug coverage.
- Private-Fee-For-Service (PFFS): PFFS Plans do not require you to select a primary care physician or get referrals. If there is a provider network, you can typically receive care outside the network if the provider accepts the plan’s payment terms and conditions.
- Medicare Medical Savings Account (MSA): MSA Plans have a high deductible and savings account. You will need to pay the high deductible before you can receive coverage from the plan. However, the plan will deposit funds into the savings account that can be used to pay on the deductible.
Eligibility and Enrollment
To qualify for Medicare Advantage, you must first be enrolled in Original Medicare. You must continue paying your Part B premiums and not drop your Part B coverage. Dropping Part B will ultimately result in you losing your Medicare Advantage plan.
You can enroll in Medicare Advantage during certain enrollment periods:
- Initial Enrollment: This period begins three months before you turn 65 and ends three months after.
- Annual Enrollment: This period begins on October 15 and ends on December 7. You can switch from Original Medicare to Medicare Advantage. You can also switch advantage plans or disenroll and switch back to Original Medicare.
- Medicare Advantage Open Enrollment: This period begins on January 1 and ends on March 31. During this period, you can switch to another advantage plan or switch back to Original Medicare.
- Special Enrollment: Several circumstances can make you eligible for a Special Enrollment Period that will grant you the opportunity to make changes to your coverage. For example, if you move out of your plan’s service area or lose your current coverage.