A privatized way that Medicare beneficiaries can choose to receive their health benefits
Medicare beneficiaries that opt into a Medicare Advantage plan no longer receive their benefits from the government (Original Medicare) but receive their benefits directly from the insurance company. Medicare Advantage plans include all benefits covered by Medicare Part A and Medicare Part B, but typically also include Medicare Part D prescription drug benefits.
Most Medicare Advantage plans use either HMO or PPO provider networks so if you are considering a Medicare Advantage plan make sure to check and see if your preferred doctor or hospital is in the network.
Since Medicare Advantage plan can renew their contracts with providers at any time it is very important to check the network every year.
Anyone enrolling in a Medicare Advantage plan must also be currently enrolled in Medicare Part B and pay the appropriate monthly premium for Medicare Part B each month.
Check out our How much does Medicare Cost? a page for more detailed information.
In addition to the monthly premium for Medicare Part B, Medicare Advantage Plan premiums can vary by company, plan, and region. Many companies offer Medicare Advantage plans with $0 additional premium but BEWARE that there still may be significantly out of pocket costs incurred when you use a Medicare Advantage plan.
Medicare Advantage plans must provide benefits at least equivalent to Original Medicare. Most plans typically have set copayment amount for doctor’s visits, diagnostic tests, inpatient hospital stays (usually a set copayment per day in the hospital). Medicare Advantage plans also must have a yearly out of pocket maximum for your healthcare costs. For 2017, the highest your medical costs can be is $6,700. The out of pocket maximum for a Medicare Advantage plan does not include prescription drug costs.
Since most Medicare Advantage plans include Part D prescription benefits it is important to know that your Part D copays, deductibles, etc. DO NOT count towards the out of pocket maximum on a Medicare Advantage plan.
The Part D benefits within a Medicare Advantage plan essentially work the same as they would with a stand alone prescription drug plan. See Medicare Part D for more information.
When you turn 65 the enrollment window for a Medicare Advantage plan is the same as your enrollment window for Original Medicare. This includes three months before your Medicare Part B effective date, the month of your Medicare Part B effective date, and three months after the month Medicare Part B begins. This means you have a seven-month Initial Open Enrollment Period. You may also qualify for a Special Enrollment Period if you are losing employer benefits or moving to a different service area.
Medicare Advantage plans also observe the same Annual Election Period as Medicare Part D. This annual period starts on October 15th each year and ends on December 8th. During the Annual Election Period you can either:
Leave Original Medicare to enroll in a Medicare Advantage plan.
Change to a different Medicare Advantage Plan.
Leave Medicare Advantage to enroll in a Part D prescription drug plan.
Unfortunately, if you wanted to change your Medicare Advantage plan but missed the deadline you will not (in most cases) be able to change until the Annual Election Period next year. But, if you want to leave your Medicare Advantage plan for Original Medicare and missed the December 8th deadline you can also use the Annual Medicare Advantage Disenrollment period which starts January 1st and ends on February 14th (Happy Valentines Day!)
During this time you will have the opportunity to disenroll from your Medicare Advantage plan and enroll in a Part D prescription drug plan only. It is important to also make sure that you are eligible for a Medicare Supplement plan before disenrolling from Medicare Advantage.
We are Medicare brokers who know the details and are eager to help you get into the right plan.