Medicare Advantage – What is it?

2 min read

Medicare Advantage health plans offer different coverage compared to original Medicare. This article will provide an overview on Medicare Advantage, the cost, the doctors you can see, what is covered, and who is eligible.

Price

Med Advantage has different plans and the set amount for premiums, deductibles, and services vary per plan. You will have to pay the Part B premium, which in 2019 the standard Part B premium amount was $135.50 (it may be higher depending on your income). Some plans have a $0 premium or may help pay all or part of your Part B premiums. Out of pocket cost varies on what plan you pick, if you stay in the network, the type of health care you receive and how often you receive it, and how much you pay for copay.

Overall, plans may have lower out-of-pocket costs for certain services. There is also a yearly limit for out-of-pocket expenses for Medicare Part A and Part B covered services. After reaching the limit you will not have to pay Part A and Part B covered services for the remainder of the year. You cannot nor do you need to buy Medigap, also known as supplemental coverage, as Med Advantage includes those services.

Doctor and Hospital Choice

Another major difference between the two is who you can see. Original Medicare allows you to go to any doctor or hospital in the United States if they take Medicare. With Med Advantage you will have to stay within the plan’s network. This applies only for non-emergency and non-urgent care, all Med Advantage plans cover emergency and urgent care. You will also likely require a referral to see a specialist. It is recommended to ask your doctors if they take Med Advantage Plans.

Coverage

What does Medicare Advantage cover and how is it different from original Medicare? Plans must cover all the medically necessary services that original Medicare covers and some plans offer extra benefits that original Medicare does not cover. Some examples of these extra types of coverage includes vision, hearing, and dental. Plans cover more of these additional services than in the past. Prescription drug coverage is included in a majority of the plans although in some cases a service or supply will require approval ahead of time to be covered. 

One of the biggest changes for Medicare Advantage is the focus on aging in place by providing certain in-home services not previously covered. Different Med Advantage plans offer different in-home options so it is important to pick the plan that fits your individual needs. Some plans cover memory care and assisted living facilities as in-home settings.

Other coverage options include adult day care services, and assistance with daily living such as cleaning, cooking, and personal grooming. Personal safety devices and medical alert systems are offered in some plans. Medical and non-medical transportation, meal delivery, respite care, massage therapy, acupuncture and installation of grab bars and ramps may also be included.

Eligibility

Eligibility for Medicare Advantage is the same as original Medicare. You are eligible if you are:

  • 65 years of age or older
  • Under 65 and permanently disabled
  • Under 65 and have end-stage renal disease or Lou Gehrig’s disease

Medicare Advantage is different from original Medicare in a lot of ways, the most notable being it is seen as an “all in one” option. This includes additional benefits such as hearing, dental, and vision that original Medicare does not cover. Using Medicare Advantage does require you to stay within the network and may require referrals in order to see a specialist.

Within Med Advantage there are different plans so knowing your own needs is vital in picking a plan that works for you. To compare Medicare Advantage plans start by looking through the health plans available in your area and enroll in the plan. For links and a step-by-step process go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Contact information for Medicare Advantage plans

Aetna: 1-855-335-1407 (TTY: 711)7 days a week, 8 AM to 8 PM. 

Cigna: 1 (877) 268-9688 (TTY: 711), 8:00 am — 8:00 pm 7 days a week

Humana: 1-844-321-5843 TTY:711 5 AM – 8 PM, daily

United Health Care: 1-844-876-9189, TTY 711 Hours: 8 a.m. to 8 p.m., 7 days a week

AARP: 1-800-850-6807, (TTY 711), Hours: 8 a.m. – 8 p.m., 7 days a week

Sources

Medicaid

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