Medicare Advantage

Medicare Advantage (Part C) Explained

A Medicare Advantage plan (Part C) is a private insurance option that allows you to receive your Part A and B benefits in a different way. When you enroll, Medicare pays a monthly fee to the plan to manage these benefits.

While you’re enrolled in a Medicare Advantage plan, you must also remain enrolled in Medicare Part A and B. Medicare pays the Advantage plan to assume your medical risks, which is how these plans are funded.

When you receive care, you’ll show your Advantage plan ID card. Your healthcare providers will bill the plan directly rather than Original Medicare. This is why some refer to these plans as Medicare replacement plans. However, keep in mind that you can return to Original Medicare during the annual election period.

Each Medicare Advantage plan has its own Summary Of Benefits, a document that outlines the plan’s specific details such as what your co-payments will be for various healthcare services.

You may pay only $10 to see a primary care doctor whereas a specialist visit will often be slightly more, and even higher co-pays for things like diagnostic imaging, hospital stays, and surgeries.

Some Medicare Advantage plans offer limited benefits for routine dental, vision, or hearing, and may even include gym memberships and money that can be used for everyday OTC products.

Senior Insurance Plans can help you review the plans in your area to understand your available options.

Medicare Advantage Enrollment Periods

Medicare Advantage plans have specific enrollment periods. You can enroll for the first time during your Initial Enrollment Period when you turn 65. After that, you can only enroll in or dis-enroll from a plan during designated times throughout the year. Once you enroll in a Medicare Advantage plan, you must remain enrolled for the entire calendar year. Dis-enrollment is only possible during certain times unless you qualify for a special enrollment period due to specific circumstances.

The most significant opportunity to change your Medicare Advantage plan is during the Annual Election Period, which occurs every fall from October 15 to December 7. Any changes you make during this time will take effect on January 1.

Things To Know

When enrolling in an Advantage plan (Medicare Part C), you choose to receive your Medicare benefits from a private insurer, rather than through Original Medicare.

Medicare Advantage (Part C) plans function within specific network areas, which can vary in terms of flexibility based on the type of plan. There are various enrollment periods throughout the year for Advantage plans, including your Initial Enrollment Period and the Annual Election Period, among others.