Are you wondering how Medicare made it easy for individuals with hospitalization and medicine treatment needs? Meeting the program’s eligibility requirements can help you get health insurance coverage and benefits. For the majority of us, choosing the Medicare Advantage Plan, also known as Part C, to help cover other medical expenses seems a better option.
So, what is the Medicare Advantage Plan exactly? This article aims to help people understand how Medicare Advantage works, its applications, and its coverages.
What Is Medicare Advantage?
Medicare Advantage plans, sometimes referred to as Medicare Part C, replace Medicare Part A, B, and D benefits by offering inpatient, outpatient, and typically prescription medication coverage.
Joining a Medicare Advantage plan does not change the fact that a person has Medicare; however, they do require members to pay Medicare Part B premiums in addition to any other costs incurred by the plan.
Medicare Advantage plans usually have lower out-of-pocket costs than Original Medicare and may offer additional benefits, but they also require members to receive care from providers in their network.
How Medicare Advantage Plans Work
Medicare Advantage program is offered by commercial insurance providers in the U.S. These businesses and Medicare has an agreement in place for these businesses to provide the same services that Medicare provides. After enrolling in Original Medicare, then you are qualified to enroll in a Medicare Advantage plan.
Any hospital services covered by Medicare Part A as well as any healthcare services covered by Medicare Part B, fall under this healthcare plan. Certain Medicare Advantage plans also provide coverage for extra medical requirements, such as:
- Dental
- Vision
- Hearing
- Prescription medications
How to Qualify for Medicare Advantage
You have to initially be enrolled in Original Medicare (Parts A and B) in order to be eligible for a Medicare Advantage Plan. The Initial Enrollment Period (IEP), which is the seven-month period that starts three months before the date that you turn 65 years, including the month you turn 65, and ends three months after the month you turn 65, is when you can enroll in a Medicare Advantage Plan. Additionally, enrollment is available during the Annual Enrollment Period (AEP), which is held annually from October 15 to December 7.
Here are a few factors to qualify for Medicare Advantage:
- Proof of Age and Citizenship/Residency — Similar to the Initial Enrollment Period, you may need documents like a birth certificate or passport.
- Social Security Information — Social Security number or proof of application for Social Security benefits.
- Proof of Current Health Coverage — If you’re currently covered by other health insurance, provide documentation of your existing coverage.
How to Apply for Medicare Advantage
Once you are eligible and have enrolled in Original Medicare, you can explore the available Medicare Advantage plans in your area. Plans may vary in terms of coverage, premiums, provider networks, and additional benefits.
- Enroll in Original Medicare — You must first be enrolled in Original Medicare (Parts A and B) before you can enroll in a Medicare Advantage Plan.
- Find a Medicare Advantage Plan — During your application period, you must reside in the service region of a Medicare Advantage insurance provider that is taking on new clients. To compare Medicare Advantage plans in your area, utilize Medicare’s Plan Finder tool.
- Contact Insurance Companies Directly -— You can also contact the insurance companies that offer Medicare Advantage plans directly. Many insurers have online enrollment options or can provide information on how to apply by phone or mail.
- Work with an Insurance Agent —- If you prefer personalized assistance, you can consult with a licensed insurance agent who specializes in Medicare plans. Agents can help you understand your options, compare plans, and assist with the enrollment process.
- Complete the Application — Whether you apply online, by phone, or through the mail, you’ll need to complete the application form provided by the insurance company offering the Medicare Advantage plan. Be sure to provide accurate and up-to-date information.
- Receive Confirmation —- After successfully enrolling in a Medicare Advantage plan, you will receive a confirmation, and your coverage will typically begin on the first day of the month following your enrollment.
Frequently Asked Questions
What is the cost of a Medicare Advantage plan?
The cost of a Medicare Advantage plan can vary widely. Some plans may have $0 premiums, while others may require a monthly premium. Additionally, beneficiaries are still responsible for paying the Medicare Part B premium. Out-of-pocket costs such as copayments, deductibles, and coinsurance also apply. It’s essential to carefully review each plan’s costs to determine what fits your budget.
Can I keep my current doctors with a Medicare Advantage plan?
Medicare Advantage plans often have provider networks, and whether you can keep your current doctors depends on whether they are in the plan’s network. Some plans offer out-of-network coverage, but going out of-network may result in higher out-of-pocket costs. Checking the provider network of the plan you’re considering is important to ensure it includes your preferred healthcare providers.
Do Medicare Advantage plans cover prescription drugs?
Many Medicare Advantage plans include prescription drug coverage, known as Medicare Part D. However, not all plans provide this coverage, and in such cases, beneficiaries may need to enroll in a standalone Part D plan. If prescription drug coverage is important to you, it’s crucial to choose a Medicare Advantage plan that includes it or enroll in a separate Part D plan.
Can I switch Medicare Advantage plans during the year?
In general, Medicare beneficiaries can only make changes to their Medicare Advantage plans during designated enrollment periods. Additionally, the Medicare Advantage Open Enrollment Period (OEP) from January 1 to March 31 allows individuals already enrolled in a Medicare Advantage plan to make one change.
Conclusion
For participants who would want to have all of their medical coverage under one roof, Medicare Advantage plans are an excellent choice. If you are already enrolled and have been thinking about purchasing a Medicare Advantage Plan, AHG Brokers can help you make wise decisions for your healthcare needs. Contact us today.