What is
Medicare Advantage?
If Medicare seems complicated, you’re not alone. With separate plans for prescription drugs and doctor visits, it can be a lot to manage. Fortunately, there’s an easier way: a Medicare Advantage Plan combines coverage for prescription drugs, doctor visits and more into one policy.
Medicare Advantage Plans, or MA Plans, are alternatives to Original Medicare plans. They’re offered through private insurers who are contracted with the federal government. The licensed health insurance agents at Southern Plains Insurance Group are qualified to help you select a Medicare Advantage Plan from some of the top carriers.
Original Medicare includes Part A (hospitalization coverage) and Part B (doctor visit and outpatient services coverage). Medicare Part C, or Medicare Advantage, covers all of these services in one plan, along with benefits for prescription drugs and more.
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Medicare Advantage Plan
Features
Coverage
Medicare Advantage covers the same medically necessary services as Original Medicare, plus Medicare Part D prescription drug coverage is included in most plans. There may be additional benefits you won’t find with Medicare Part A and Medicare Part B, such as hearing, dental and vision care coverage.
Costs
Your premiums and deductibles will vary, but Medicare Advantage monthly premiums may be lower than Original Medicare. Unlike Medicare Part A and Part B, there’s a limit on the amount you pay for covered services each year. With Medicare Advantage, you’ll have a maximum out-of-pocket cost for coinsurance and deductibles.
Eligibility
To qualify for Medicare Part C, you must first be enrolled in Medicare Part A and Part B (Original Medicare). You also have to live in an area with a provider who accepts Medicare Advantage insurance. This includes those under age 65 and who’ve qualified for Medicare due to a disability. Additionally, people with certain health conditions may be eligible for Medicare Special Needs Plans.
How Southern Plains Insurance Group Can Help You
Trusted Health Insurance Agents
Why spend your precious time sifting through hundreds of options to find the right Medicare coverage and benefits? There’s so much information out there that it can be hard to find the answers you’re looking for. And if you have questions, who do you turn to?
Southern Plains Insurance Group does the research for you and then provides you with all of the information you need. We’ll take the time to explain your options and answer all of your questions. As a licensed insurance broker, we can help simplify your coverage with a Medicare Advantage Plan:
- Receive personalized recommendations and advice on the best policy for you
- Get help comparing plan benefits and costs
- Fully understand the Medicare Advantage plans available to you
- Feel confident in your Medicare Advantage plan selection
Medicare Advantage FAQs
What are Medicare Advantage Plans?
There are two parts to Medicare: Part A, which covers hospitalization, and Part B, which covers doctor’s visits and other outpatient services. Medicare Advantage Plans are a type of Part C coverage, and they’re offered by private insurance companies. These plans combine Parts A and B, and they often include additional benefits like prescription drug coverage. So if you’re looking for a way to get the most out of your Medicare coverage, a Medicare Advantage Plan might be the right choice for you.
What Does Medicare Advantage Cover?
Medicare Advantage is a combination of Medicare Part A, Part B, and sometimes Part D.
Medicare Part A is sometimes called “hospital insurance.” That’s because it covers inpatient care in hospitals, skilled nursing facility care, home health care, and hospice care. Basically, if you need to be admitted to a hospital or require any of the other listed types of care, Medicare Part A will help cover the costs. Part A also covers some short-term stays in rehabilitation facilities and long-term care hospitals. So if you’re ever feeling under the weather, make sure to give Medicare Part A a call. Chances are it will have you covered.
Medicare Part B covers things like medically necessary services, preventive care, mental health care, doctor visits, medical equipment, and ambulance services.
Medicare Part D covers prescription drugs. Under Part D, eligible beneficiaries can receive coverage for a portion of the cost of their prescription drugs. There are two ways to obtain coverage: through a stand-alone Part D plan or through a Medicare Advantage plan that includes Part D coverage. While the details of coverage vary from plan to plan, all Part D plans must offer at least a basic level of coverage for a broad range of drugs.
Other benefits include over-the-counter allowances, routine dental care, hearing aids, routine vision services including glasses and contacts, fitness programs, and meal delivery. Long-term care is covered for when you need specialized nursing services due to a qualifying medical condition.
What Does Medicare Advantage Not Cover?
Similar to Original Medicare, Medicare Advantage does not cover:
- Elective services like cosmetic surgery
- Healthcare services performed outside of the United States
- Long-term care including custodial care
How do Medicare Advantage Plans Work?
Medicare Advantage plans add services to your existing Original Medicare plan. Most of your Medicare Part A and Part B services will be provided through your Medicare Advantage plan.
Who is Eligible for a Medicare Advantage Plan?
- If you’re currently enrolled in Original Medicare Part A and Part B.
- You’ve lived in the Medicare Advantage plan’s coverage area for at least 6 months.
When Can You Enroll in Medicare Advantage?
There are four different enrollment periods during which you can either join or drop a Medicare Advantage plan:
Initial Enrollment Period
The seven-month window where you can enroll in Medicare Advantage. It begins 3 months prior to your 65th birthday and then 4 months after that.
Medicare Advantage Open Enrollment
Open enrollment is from January 1 – March 31, and your Medicare Advantage coverage will begin July 1. If you signed up for Medicare Part B for the first time during open enrollment, then your Medicare Advantage enrollment period is extended to June 30.
Medicare Advantage Fall Enrollment Period
Medicare’s open enrollment is October 15 – December 7. During this time, anyone is allowed to add, switch or drop a Medicare Advantage plan. If you enroll in the fall, then your Medicare Advantage coverage begins January 1.
Special Enrollment Periods
You can enroll in Medicare Advantage outside of normal enrollment periods if these circumstances apply to you:
- An address change that affects your Medicare Advantage coverage
- Loss of existing coverage
- Your current plan has dropped is contract with Medicare
How Much does Medicare Advantage Cost?
That’s a great question, and it really depends on your unique situation. Premiums, out-of-pocket maximums, and drug costs depend greatly on the available Medicare Advantage plans. Southern Plains Insurance Group can consult with you on your current and future needs, and we can recommend the lowest-cost plan available.