Also called Plan C, Medicare Advantage includes everything offered by the Original Medicare and some more. While the Original Medicare Plans A and B offer federal coverage for most medical services, the Medicare Advantage plan offers something extra through private insurance providers pre-approved by the facility. The Advantage plan is not the same as Medicare Supplemental Insurance or Medigap.
What does Medicare Advantage cover?
An all-in-option, Medicare Advantage is also called MA Plans or Part C. These are bundled plans that include hospital insurance offered by Medicare Part A and medical insurance offered by Plan B.
Additionally, Medicare prescription drug coverage offered by Plan D is also sometimes included in Plan C. Thus, the Advantage plan covers all of Medicare services. Extra services, such as dental, vision, and hearing are also covered.
Along with these various medical coverages, the Advantage plan will also charge out-of-pocket expenses.
Is there any maximum out-of-pocket limit with Medicare Advantage?
It is mandatory for every Advantage plan of Medicare to set an annual limit on out-of-pocket medical expenses. It is also called MOOP or maximum out-of-pocket. Usually, this limit is set at a higher benchmark. However, such high MOOP can be a useful protection against excessive medical expenditure, especially when one requires expensive care or treatment.
In some Advantage plans of Medicare, MOOP may be applicable to hearing, vision, dental, and other supplemental benefits. Plans that cover services from out-of-network medical service providers have two annual limits: one for combined out-of-network and in-network expenses and the other for in-network expenses.
As of 2020, the maximum out-of-pocket limit for Advantage plans is set at around $6,700. Certain plans may have a lower limit.
What are the various types of Medicare Advantage plans?
There are basically four types of Medicare Advantage plans. HMO or Health Maintenance Organization plan is the most common plan that accounts for the most number of enrollments in Medicare Advantage. For a fixed fee (monthly or annually), HMOs offer medical insurance coverage through a network of pre-approved physicians.
PPO or Preferred Provider Organization is another type of MA plan that offers coverage through a network of participating healthcare providers. Unlike HMO, PPO offers the option of seeking healthcare outside the pre-approved network, but at higher premiums.
Other types included in Plan C are PFFS or Private Fee-for-Service Plans and SNPS or Special Needs Plans. MSA or Medical Savings Account and HMO-POS or HMO Point-of-Service are some of the lesser-known Medicare Advantage plans.
Are there any eligibility criteria?
The basic eligibility criteria to enroll in any of the Medicare Advantage Plans is that one’s residence must be in the service area of the plan. If one’s place of residence is another state for some parts of the year, it is important to enquire and get confirmation whether the plan will provide coverage in another state as well.
To get further information about a plan’s service area, make sure to read through all the documentation. Additionally, it is mandatory to enroll for Medicare Part A and Part B. Also, the person enrolling in the plan should not have end-stage renal disease.
How can one join an Advantage plan of Medicare?
There are multiple Advantage plans under the umbrella of Medicare. However, each plan will work in different ways. Prior to enrollment, ensure to shop and compare the plans available in the area of residence. One can use Medicare’s Plan Finder tool to join a suitable plan. Before joining, it is essential to read and understand all the terms and conditions along with the costs of the various plans.
Once one has figured out which plan to enroll in, they can visit the website of the specific plan. Paper enrollment is also possible. Another way is to call the plan one has chosen and follow the procedure mentioned. While enrolling, one must have ṭheir Medicare number handy and ṭhe start date of Part A and Part B.
Never give out personal and financial information, including bank account and credit card details over the phone.