What is Medicare Advantage

What is Medicare Advantage?

Medicare Part C is commonly called “Medicare Advantage.” Medicare Advantage Plans are a type of Medicare health plan offered by private companies that contract with Medicare. To be eligible for Medicare Advantage/Part C coverage, you must have both Parts A and B.

Medicare Part C is an alternative to Original Medicare that includes Parts A and B, and usually Part D (Prescription Drug Coverage).

  • Part C plans usually require beneficiaries to see in-network providers.
  • Most Medicare Advantage (MA) plans offer additional benefits not found in Original Medicare, like dental, hearing, and vision services.

If you are enrolled in a Part C Medicare Advantage Plan, most Medicare services are covered. Medicare Advantage enrollees will incur copays and coinsurances paying for services as they are utilized.

A Medicare Advantage plan sets a Maximum Out-of-Pocket limit to the amount of copays and coinsurances you pay per year. Most Medicare Advantage plans have network restrictions. Plans that allow you to see doctors outside of the network will have separate max out-of-pocket limit based on whether they are in or out of network. Below are the most common types of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Special Needs Plans (SNP’s)

Medicare MSA Plan

Some private insurance companies offer a consumer-directed Medicare Advantage Plan called a Medicare MSA Plan. These plans are like Health Savings Account Plans and are available outside of Medicare. Beneficiaries can go to any Medicare-participating provider and use the money in their account to pay for any covered services. An MSA Plan must cover all the same services that a Medicare Advantage Plan is required to cover.

Medicare MSA Plans Have Two Parts:

Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.

  1. High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
  2. Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account which you can use to pay for health care costs before you meet the deductible. Once you meet your deductible, the plan will pay 100% for covered services.

MSA plans do not cover Part D benefits. Beneficiaries in an MSA must get a standalone Prescription Drug Plans for drug benefits.

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