Medicare Advantage Plans, also known as Medicare Part C or MA Plans, are an alternative coverage option to Original Medicare Parts A and B.
These plans do not supplement Original Medicare. They are health plans offered by Medicare-approved private companies that must follow rules set by Medicare. Medicare pays a fixed amount each month to the company offering that plan for coverage of each beneficiary enrolled. These plans offer coverage for Medicare Part A and Part B services and some plans may offer coverage for things Original Medicare doesn’t cover (such as routine dental or vision services, hearing aids, wellness programs, etc.). These plans may or may not include a Medicare Part D Prescription Drug Plan.
Medicare beneficiaries considering enrolling in a Medicare Advantage Plan should understand the costs associated with that plan as each plan’s cost structure may differ from Original Medicare.
Medicare Advantage Plans have yearly contracts with Medicare. Each year the plans set the amount they charge for premiums, deductibles, covered service copayments/coinsurance. Plans must notify current members by sending out an Annual Notice of Change (ANOC) in September, before the start of the Annual (Fall Open) Enrollment Period for the coming year.
In many cases, the beneficiary needs to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what the out of pocket costs are each year for covered services, which helps the beneficiary to plan their budgets. Some plans offer out-of-network coverage, but sometimes at a higher cost. Providers can join or leave a plan’s provider network at any time. The plan can also change the providers in their network at any time. A new provider may need to be selected if either of these situations occur.
The best way to get all the facts regarding any plan is to review the plan’s Evidence of Coverage. This plan document describes in detail the plan’s benefits, how much the beneficiary will pay, how the plan works (including networks, coverage limits, prior authorization rules, etc.). To access this document, go to the plan’s website and search for plan’s Evidence of Coverage link (usually a PDF document).
CAUTION: Television and Print Advertising/Marketing
of Medicare Insurance Options In general, the purpose of these ads is the solicitation of insurance, to get the beneficiary to take action, to call the number on the screen (or the number on the card/letter). While the information presented in these ads about costs and benefits may be true, to the extent that it was said, there is much left unsaid and that is the important information a person needs to know to make an informed decision about their health care coverage, especially understanding how switching to another plan will affect a person’s current insurance coverage. All beneficiaries are encouraged to go beyond beyond the advertisements to get the facts about the insurance options available to them. |
