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How Do Medicare Advantage Plans Work?

Page Reviewed / Updated - August 10, 2020

Medicare Advantage plans cover all the services that regular Medicare plans cover. However, Medicare Advantage plans also offer coverage for other kinds of health care services and supplements to basic health care coverage.

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These companies must follow the rules for coverage set by Medicare. Different plans have different out-of-pocket costs, and these costs may vary from location to location, even with the same provider.

Medicare Advantage Plans are also known as Medicare Part C or MA plans. Seniors who need coverage beyond what traditional Medicare (Part A and Part B) offers may opt to purchase this type of supplemental Medicare insurance.

Joining a Medicare Advantage Plan doesn't mean that applicants lose their Medicare coverage. In fact, seniors must be enrolled in Medicare in order to apply for a Medicare Advantage plan. Enrollees pay a monthly premium for services and may be required to pay a co-pay or coinsurance for services rendered.

The rules for Medicare Advantage plans can change from year to year, so it's important to review the changes before re-enrolling in a plan.

What Do Medicare Advantage Plans Cover?

Although Medicare Advantage plans cover all the services that regular Medicare plans cover, many also offer extra services, such as vision exams and glasses, hearing screens and hearing aids, and dental coverage, including dentures.

Some Medicare Advantage plans may also cover preventative health care services, such as gym memberships or healthy food. Meal preparation coaching and home health care are also options for some plans. Transportation to medical appointments, over-the-counter medications, adult day care services and services tailored to people with chronic illnesses are also options for coverage.

All supplemental Medicare plans must cover emergency and urgently needed medical care, and emergency services are covered even if the patient is treated out-of-network. However, services that the Medicare Advantage plan provider deems medically unnecessary may not be covered, and patients may have to cover all of the expenses themselves.

Prescription drugs are typically covered by Medicare Part D plans. It's important to review the details of these plans to determine which medications are covered and whether generic versions of branded medication are available. Other drug coverage plans include Medicare Medical Savings Account plans, a separate type of plan that just covers drugs.

Bear in mind that applicants can be disenrolled from a Medicare Advantage plan and returned to Original Medicare if they are in a Medicare Advantage HMO or PPO and join a separate Medicare prescription drug plan.

How to Enroll in a Medicare Advantage Plan

Enrolling in a Medicare Advantage Plan is fairly straightforward. Applicants begin by using the Medicare Plan Finder tool to locate plans available in their city or state of residence. Then, they can review what each plan offers, including co-pays, coinsurance and a list of in-network providers, which is important since many seniors prefer to remain under the treatment of their current care providers. The plan may also provide a list of preferred specialists, including dentists, optometrists and hearing doctors.

Many Medicare Advantage plans are available for online enrollment. Applicants need their Medicare number and the date their Medicare Part A or Part B coverage started, both of which can be found on the Medicare insurance card. All Medicare Advantage providers offer paper application forms for those who prefer this format.

Unlike traditional Medicare, which has certain open enrollment periods for enrolling and changing coverage, applying for supplemental Medicare can be done at any point throughout the year.

For questions, call the Medicare helpline at 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 for TTY services.