Medicare Advantage

Medicare Advantage, also known as Part C, brings you the coverage of Original Medicare with additional prescription drug coverage. You enroll in a Part C plan through a Medicare-approved private insurance company. Medicare compensates these private insurance companies for taking care of your Part A and Part B coverage. These plans have a vested interest in your health, so many also offer prescription drug coverage, dental, health, vision care, and sometimes gym memberships, none of which are covered under Original Medicare.

Private, Medicare-approved health insurance companies offer Medicare Advantage plans. Medicare compensates these companies with a “premium” to handle your Part A hospital and Part B medical coverage. The advantage plan serves as the primary insurer, paying the bills for Medicare-covered services with help from the compensation from Medicare itself. That means you need to keep your Medicare card safe and instead show healthcare providers your Medicare Advantage card at the time of service so they can be billed properly.

Coverage Under Medicare Advantage

Each Advantage plan has its own summary of benefits. This summary will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, lab work, and so on. Most Medicare Advantage plans also have prescription drug coverage similar to Part D.

One neat thing about Medicare Advantage plans is that some of them offer minor benefits for routine dental, vision, or hearing. Some plans include gym memberships. When searching for Medicare Advantage plans with dental and vision, we can help you compare those extra benefits between carriers.

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Costs for Medicare Advantage

On top of your premium, you can expect to pay copays when you visit a healthcare provider. Members pay copays at the time of service. You might pay $10 to see a primary care doctor. Specialists will often be more – a $50 specialist copay is quite common. Some of the higher copays may come in for diagnostic imaging, hospital stay, and surgeries.

You can usually expect to spend several hundred on copays for these items. However, this varies greatly between states, so review plans in your area to get the specifics.

Enrolling in Medicare Advantage

To be eligible to enroll in a Medicare Advantage plan, you must be 65 or older, be enrolled in Part A and Part B, and live within the plan’s service area. There used to be restrictions for people with End-Stage Renal Disease (ESRD), but these were lifted in 2021.

You can first enroll in a Medicare Advantage plan during your Initial Enrollment Period, which begins three months before the month of your 65th birthday and extends three months afterward. After Initial Enrollment passes, you can sign up during the Annual Election Period from October 15 to December 7.

The Annual Election Period in the fall is the most common time to change your Medicare Advantage plan. This period runs from October 15th – December 7th each fall. Changes made to your enrollment will take effect on January 1.

If you decide to leave a Medicare Advantage plan and return to Original Medicare, you must notify your Medicare Advantage plan carrier. Otherwise, Medicare will continue to show that you are enrolled in the Advantage plan instead of Medicare.

You must maintain your Part B coverage even though you have a Medicare Advantage plan. If you drop it, you will be immediately kicked out of the Part C plan.

If you live in Illinois, Missouri, or Iowa, give us a call today. We can help you find a Medicare Advantage Plan in your area.