What is Medicare Advantage and How Does it Work?

Medicare Advantage Plan (Part C) is a type of health plan approved by Medicare from a private company that you can choose to cover most of your Part A and Part B benefits instead of the Original Medicare plan. It usually also includes drug coverage (Part D). Part A (hospital coverage) covers aspects such as hospitalizations, home health care and some care in specialized nursing facilities. Together, Medicare Parts A and B are referred to as Original Medicare.

Medicare Advantage, also known as Medicare Part C, is a private health insurance option designed to cover any shortages in Part A and Part B. Some Medicare Advantage plans provide coverage for vision, dental and hearing expenses. They are considered an alternative to Original Medicare and cover all expenses incurred with Medicare. However, if you have health insurance through a current job or are on your spouse's active plan, you can delay your enrollment in Medicare Part B without penalty.

Services like these can be covered through private Medicare health plans and Medicare Part D prescription drug plans. Some Medicare Advantage plans have benefits that help pay for acupuncture services in addition to Medicare, such as treating chronic pain in other parts of the body, headaches and nausea. If a polyp or other tissue is found and removed during a colonoscopy, Medicare applies an additional share in the cost of services. Like other types of health insurance, each Medicare Advantage plan has different rules about treatment coverage, patient liability, costs, and more.

Medicare Advantage plans, sometimes referred to as Part C or MA plans, are offered by private companies approved by Medicare that must follow the rules set by Medicare. People can change their Medicare Advantage plans during a specific open enrollment period in the fall, which generally runs from mid-October to early December.

For example, with Original Medicare you have coverage for going to almost every doctor and hospital in the country. On the other hand, Medicare Advantage, or Medicare Part C, is a type of Medicare plan that uses private health insurance to cover all the services you would receive under Parts A and B.

This amount can vary each year and depends on how long you or your spouse worked and paid Medicare taxes. You can't have Medigap and Medicare Advantage at the same time, so it's up to you to determine what type of plan best suits your needs. Both Medigap and Medicare Advantage serve as solutions that fill the “gaps”, so to speak, in original Medicare coverage. Each Medicare Advantage plan must provide all the Part A and Part B services covered by Original Medicare, but they can do so with different rules, costs and restrictions that may affect how and when you get care.

However, Medicare Advantage plans often have network restrictions, meaning you'll likely have a more limited choice of doctors and hospitals. Some Medicare Advantage plans cover additional costs that Medicare doesn't pay, including expenses related to vision, dental and hearing.

Elise Woehl
Elise Woehl

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