The FAQs about Medicare Advantage Plans

Medicare Advantage plans can take the place of Medicare Part A, Part B and Part D. 

1. What are Medicare Advantage Plans?

Medicare Advantage (MA) plans are a kind of Medicare health plan offered by a private company in contract with the federal Medicare program. Also known as ‘Part C,’ the MA plan provides you with all your Part A (hospital insurance) and Part B (medical insurance) benefits. If you enroll in an MA plan, all of your Medicare services will be covered through the plan and will not be paid for under Original Medicare.

In order to enroll in a Medicare Advantage plan, you must meet all of the following requirements:

• You are eligible for Medicare Part A and Part B
• You are not suffering from end-stage renal disease (ESRD)
• You live in an area in your preferred plan’s coverage area.

2. How Do Medicare Advantage Plans Work?

There are several different kinds of MA plans:
       

• Medicare Medical Savings Account (MSA)

         

•   Private Fee-for-Service (PFFS)

         

•   Preferred Provider Organization (PPO)

        

•   Health Maintenance Organization (HMO)

Regardless of the plan’s structure, the federal government’s Medicare program pays a fixed amount each month for your medical care to the private insurers that provide your MA plan. Each MA plan is different and thus has a different fee structure. Medicare requires every Medicare Advantage plan to meet certain minimum coverage requirements. However, every plan has its own list of rules that determine how services are delivered to a customer, such as whether you need referrals to see specialists or you can only visit doctors within the insurer’s network. These rules change on an annual basis as required by the contract between Medicare and the private companies.

3. Do Medicare Advantage Plans Cover Prescription Drugs?

Most Medicare Advantage plans include coverage for prescription drugs. If you use certain prescription drugs on a regular basis, you’ll want to pay particular attention to the plans’ formularies, or list of covered drugs. If a particular plan has lower premiums than another but doesn’t cover a prescription you use, you could lose thousands of dollars per year.

In cases where MA plans do not offer drug coverage, you can join a Medicare prescription drug plan (Part D). If your MA plan does not offer drug coverage, double check to make sure. If your MA plan offers drug coverage and you opt for a Medicare prescription drug plan, you will be returned to Original Medicare and disenrolled from your current MA plan.

3. How Can I Join, Switch or Drop a Medicare Advantage Plan?

Switching Medicare Advantage Plans

Just join your preferred plan during the enrollment period. Your old enrollment will automatically discontinue when your new plan’s coverage begins.

Switching to Original Medicare

Call 1-800-MEDICARE or contact your current plan.

Switching When You Have Other Coverage

You can use your employer coverage along with your MA plan, but in some cases joining an MA plan could cause you to lose your employer coverage. And if you lose coverage for yourself, you will also lose coverage for your dependents and spouse. Always be careful about making such decisions, because once you lose employer coverage, you might not get it back.

5. What Should I Do if My Plan Stops Participating in Medicare?

Health plans can decide to leave the Medicare program at the end of the year. If your plan leaves Medicare, you will automatically be returned to Original Medicare if you do not join another MA plan. You will receive all services covered by Medicare but you will have to join a Medicare Prescription Drug Plan for drug coverage. You will also have the right to buy a Medigap policy.