Medicare Advantage (MA)—also known as Medicare Part C—is a stand-alone option to traditional Medicare that is basically structured as a managed-care plan. Other points to know:
- Medicare Advantage is not the same as a Medigap Policy. It replaces traditional Medicare Parts A & B. Medigap does not work with or pay after MA.
- Medicare Advantage is sometimes called a “Medicare Health Plan” or “Medicare Replacement Plan.”
- These plans are sold by private insurance companies with Medicare approval.
- These plans may offer additional benefits such as vision, dental, hearing or transportation—but it’s important to get specific coverage details in writing, before you join a plan.
- There are five types of Medicare Advantage Plans. Most require use of a network of certain doctors and hospitals (providers). Use of out-of-network providers means you pay more or possibly all the cost of your healthcare.
- These plans may have special rules to follow—such as prior authorization required for some therapies or treatments.
- Coverage is not standard and varies from state to state…and even county to county. Federal law requires MA cover the same benefits as Original Medicare but the costs such as deductibles and copays vary.
- Some MA plans include prescription drug coverage.
- Some MA plans may include vision, home meal delivery after surgery, gym membership, hearing, or dental coverage.
Cost sharing may be better for some consumers under an MA plan. Arkansas SHIIP offers this example:
Original Medicare hospital coverage requires a deductible of $1,156 in 2012. An MA Plan might change the cost sharing so the patient pays $200 per day for the first five days. If the patient stays two days, they owe $400 vs. the Original Medicare deductible of $1,156. If the patient stays five hospital days, they owe $1,000 vs. Original Medicare $1,156.