If you’re nearing age 65, it’s essential to understand how Medicare works. By reading up on it now, you can avoid some potential pitfalls. Medicare Advantage is a critical part of Medicare that you’ll want to understand.
What Is It and How Does It Work?
Medicare Advantage, also known as Medicare Part C, is an additional plan you can elect to enroll in. It gives you access to all the benefits of Parts A and B, and some policies include extra services. For example, there’s usually coverage for dental, vision, and even hearing care.
Advantage plans usually work like private insurance plans. They can give you access to healthcare through an HMO, PPO, or PFFS (private-fee-for-service) plan.
Insurance companies must receive approval from Medicare before selling Part C plans. They also follow any regulations Medicare sets forth. However, insurance providers can change other rules yearly.
Many Medicare Advantage plans cover prescription drugs, called Part D. Getting Part C from a private insurance company doesn’t change the fact that you’re enrolled in Medicare. You still have the same rights and protections as anyone with equal protection.
If you sign up for Advantage, you still need to continue paying your Part B premium. You’ll pay whatever the insurance company charges for Part C, on top of that.
For most plans, Medicare decides how much the provider pays and how much an individual pays. In the case of PFFS, the insurance provider decides these amounts.
Advantage policies have an annual limit on out-of-pocket spending. So, once you reach that limit, the plan usually pays any additional covered medical expenses for the year.
This limit can fluctuate from year to year and also varies according to the policy you have. Rules for out-of-pocket costs also change depending on your plan.
You can sign up for Part C during any General Enrollment Period without paying late fees. This window is every year from January 1 to March 31. This feature is indeed an advantage, since Parts A, B, and D have a late enrollment penalty.
How to Enroll
You can register for Part C through private insurance companies. You may choose to use the online Medicare Plan Finder to search for a provider in your area. You’ll need to sign up for a free account to use this service.
Take the time to compare the plans available for your zip code. Once you have decided which is best for you, you can fill out your Advantage application. During the signup process, you’ll need to give the insurance provider your Medicare number and the date your coverage started.
You can enroll in Part C during the Initial Enrollment Period, which occurs near your 65th birthday. If you did not choose to join at that time but are interested now, it is easiest to change plans during the Open Enrollment Period from October 15 to December 7. Learn more about getting a Medicare Advantage plan on this link.
Additional Details about Medicare Advantage
To enroll in Part C, you must first have Parts A and B. You also need to live in an area where Advantage plans are available.
You can enroll in Part C even if you have pre-existing conditions. End-Stage Renal Disease (ESRD) is the only exception. Advantage plans can’t charge you more than Original Medicare for services like dialysis, chemo, and skilled nursing facility care. Part C may lower your out-of-pocket costs, making it the most cost-effective option for you.
It is always a good idea to check with your insurance company before using a new medical service. Check whether it’s covered and what costs you may incur. Your policy may require you to use specific healthcare providers from within the company’s preferred network of suppliers.