Medicare Advantage

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare:

• Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D).
• Medicare Advantage (also known as “Part C”) is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Most plans offer extra benefits Original Medicare doesn’t typically cover services like vision, hearing, dental, and more. Your Medicare health plan decisions affect how much you pay for coverage, what services you get, what doctors you can use, and your quality of care.

An individual who joins a Medicare Advantage Plan (MA)  is still in the Medicare program.  To participate in Medicare Advantage an individual must specifically opt to receive Medicare coverage through a MA plan.  Once this choice is made, the individual must generally receive all of his or her care through the plan’s providers in order to receive Medicare coverage.  One of the main goals of MA plans is to manage health care in order to reduce costs while also providing necessary care.

An MA plan must provide enrollees in that plan with coverage of all services that are covered by Medicare Parts A and B, plus additional benefits beyond those covered by Medicare.  These additional benefits may be either or both a reduction in the premiums, deductibles and coinsurance payments ordinarily required or healthcare services not covered by traditional Medicare such as dental and vision care or certain preventive services.  Many MA plans also include Part D prescription drug coverage.  These plans are known as Medicare Advantage Prescription Drug plans or MA-PDs.

MA plans differ with respect to what benefits they provide, out-of-pocket costs such as premiums, deductibles, and co-pays, and whether they provide prescription drug coverage.  It is important to remember that if you are happy with your Medicare benefits, whether you are in traditional Medicare or an MA plan, you don’t HAVE to change when the opportunity arises.  In addition, those with coverage through their current or former employer should check to see how any changes might affect such coverage.