Medicare Advantage: Overview, Types, and FAQs

What is Medicare Advantage?

Medicare Advantage (MA) is a Medicare plan provided by commercial insurers that have contracted with the program. Medicare Advantage plans, generally known as Medicare Part C, include hospitals, outpatient care, and, in most cases, prescription drugs, replacing benefits from Medicare Parts A, B, and D.

Anyone who enrolls in an MA plan still has Medicare and must continue to pay Medicare Part B premiums, as well as any plan-imposed expenses.

Medicare Advantage plans often feature lower out-of-pocket costs than standard Medicare and may include extra benefits.

KEY TAKEAWAYS

·       Medicare Advantage, often known as Medicare Part C, are Medicare-approved plans offered by private insurers.

·       Except for hospice care, Medicare Advantage plans replace inpatient, outpatient, and prescription medication benefits under conventional Medicare Parts A, B, and D.

·       MA plans sometimes demand consumers to see doctors in their network or charge higher out-of-pocket expenses for outside providers, as well as referrals to see specialists.

·       Medicare Advantage providers are paid a set cost by the program for each member and may charge policyholders out-of-pocket payments for some procedures.

How does Medicare Advantage work?

Medicare is often available to those 65 and older, younger people with disabilities, and those with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or amyotrophic lateral sclerosis (ALS).

Medicare Advantage plans are private-sector Medicare-approved programs that offer an alternative to traditional Medicare coverage. Except for hospice care, MA plans provide inpatient and outpatient coverage that replaces Medicare Parts A and B. Most MA plans also include Part D prescription medicine coverage.

In 2022, more than 28 million individuals were enrolled in a Medicare Advantage plan, representing about 48% of all Medicare enrollees.

The Medicare Advantage program pays a predetermined charge to providers for each enrolled health plan participant. Subscribers must additionally pay out-of-pocket for their plans. They may limit coverage to providers in a network while requiring referrals to specialists.
Some Medicare Advantage plans provide costs not covered by normal Medicare, such as vision, dental, and hearing care. Medicare Advantage schemes are not compatible with Medigap, often known as Medicare Supplement Insurance.

The average monthly Medicare Advantage premium for 2024 is $18.50. Medicare Advantage enrollees pay any MA plan payments on top of their monthly Medicare Part B premium, which is set at $174.70 in 2024.

Regional preferred provider organizations (PPOs) were established to increase rural members' access to Medicare Advantage plans while also serving large statewide or multi-state areas. In 2020, regional PPOs represented for 5% of all Medicare Advantage enrollees.
Types of Medicare Advantage Plans

The most frequent type of Medicare Advantage plan is the health maintenance organization (HMO). HMOs cover the vast majority of Medicare Advantage beneficiaries. Other types of Medicare Advantage plans include PPOs, PFFS plans, and special needs plans (SNPs). Less prevalent schemes include HMO point-of-service (HMOPOS) and medical savings account (MSA).
To enroll in a Medicare Advantage plan, you must live within its coverage region and have Medicare Parts A and B.

Fact: In 2021, people with end-stage renal illness were able to participate in any local Medicare Advantage plan.

End-stage renal disease (ESRD) patients will be able to enroll in any Medicare Advantage plan in their area beginning in 2021. Patients with end-stage renal disease (ESRD) should evaluate the costs and advantages of Medical Advantage plans to those of standard Medicare coverage, and ensure that their doctors and hospitals are in the network.

Special Considerations

Medicare's online plan-finder tool provides information about Medicare Advantage programs. To enroll in a Medicare Advantage plan, a customer must give the information on their Medicare card, such as their Medicare number and the dates their Part A and Part B coverage began.

People can alter their Medicare Advantage plans during a designated open enrollment period in the fall, which normally lasts from mid-October to early December.

Each Medicare Advantage plan, like other forms of health insurance, has its own set of regulations about treatment coverage, patient accountability, pricing, and other aspects. Joining a Medicare Advantage plan may exclude a person from continuing to get health care coverage via their employer or union, therefore if employment-based coverage meets a person's requirements, they should avoid enrolling in Medicare.

Medicare.gov: “How Medicare Works with Other Insurance.”

All Medicare Advantage plans include an annual out-of-pocket cost cap, which may make them more affordable for some beneficiaries. The out-of-pocket maximum for single coverage is $9,450 in 2024. For family coverage, the 2024 out-of-pocket limit is $18,900.

Medicare Star Ratings

Medicare Star Ratings are intended to assist seniors compare Medicare Advantage plans when picking which one to enroll in. They go from one to five stars, with one being the lowest and five being the

greatest. They are also based on up to 38 distinct quality and performance metrics, such as customer service, the variety of yearly screenings and preventative services provided, and chronic condition management. The ratings are given yearly ahead of the autumn Medicare open enrollment season, which runs from October 15 to December 7.

What is Medicare Advantage?

Medicare Advantage, often known as Medicare Part C, is a type of privately managed health plan contracted by Medicare to provide an alternative to standard Medicare coverage for program members. Medicare Advantage plans often replace coverage provided by Medicare Parts A, B, and D. They frequently have cheaper premiums and cover more services than standard Medicare, but they limit treatment to in-network communications and need referrals for visits with specialists.

What are the disadvantages of Medicare Advantage?

Co-pays on Medicare Advantage might add up if you're unwell. The enrollment time is short, and if you already have Medicare Advantage, you will not be eligible for Medigap coverage. Additionally, providers may quit and rejoin your network at any moment.

Can I Sign Up for Medicare Advantage with a Pre-Existing Condition?

Yes. Individuals with preexisting conditions can receive coverage via Medicare Advantage.