Medicare Advantage is an alternative Medicare option that also includes coverage for prescription drugs, dental, vision, hearing, and other health perks.
If you’ve recently enrolled in Medicare, you may be wondering who sells Medicare Advantage plans in your area. Medicare Advantage is offered by private insurance companies who are contracted with Medicare to cover your healthcare services.
In this article, we’ll review what you need to know about Medicare Advantage, how to enroll, and what to expect from the companies that offer these plans.
Medicare Advantage, also known as Medicare Part C, is Medicare coverage that private insurance companies sell. In addition to covering Medicare Part A and Part B, most Medicare Advantage plans also cover prescription drugs, as well as dental, vision, and hearing services.
Some Medicare Part C plans even cover health perks like fitness memberships and certain home health services.
Most Medicare Advantage plans cover the following services:
- inpatient hospital care
- outpatient medical services
- prescription drugs
- dental, vision, and hearing care
- additional health perks
Medicare Advantage plans can be a good option for people who want additional coverage beyond Medicare parts A and B and bundled all under one plan. Medicare Part C is also a popular option for people who want to choose from different plan structures, such as HMOs, PPOs, and more.
Medicare Advantage plans are sold by most major private insurance companies, including:
- Aetna Medicare
- Blue Cross Blue Shield
- Kaiser Permanente
Medicare Part C offerings vary from state to state, and each insurance company has the right to decide whether they will sell Medicare Advantage plans from year to year.
For example, some companies may offer plans in a few select states but not in others. This means that even if your friend is signed up for a Medicare Advantage plan in their area, that same plan may not be offered where you live.
If you are already receiving services from a major insurance provider through your employer, you can reach out and ask if they sell Medicare Advantage plans.
Another way to review all of your plan offerings is to use the plan finder tool offered by Medicare. This tool allows you to search for and compare Medicare Advantage plans in your city, state, or ZIP code.
Medicare Advantage plans include both original Medicare costs, as well as plan-specific costs. There is no single cost for enrolling in a Medicare Advantage plan because there are many factors that can affect what you will pay.
All these costs are influenced by the state where you live, the cost of living, your income, where you go for healthcare services, how often you need services, and whether you receive any type of financial assistance.
Here’s a breakdown of what you can expect to pay in 2021 when you enroll in a Medicare Advantage plan:
- Premiums. If you are not eligible for premium-free Part A, your Part A premium can cost up to $471 per month. The Part B premium costs $148.50 per month or more, depending on your income. Some Medicare Advantage plans will cover these monthly premium costs. In addition, while some Medicare Advantage plans are premium-free, some also charge a separate monthly premium for the plan.
- Deductibles. Part A has a deductible amount of $1,484 per benefit period. Part B has a deductible amount of $203 per year. If your Medicare Advantage plan covers prescription drugs, you may also owe a prescription drug deductible as well.
- Copayments. Each Medicare Advantage plan will have specific copayment amounts for visiting both primary care doctors and specialists. These amounts can differ depending on your plan structure and whether you are receiving services from an in-network or out-of-network provider.
- Coinsurance. Part A coinsurance can cost as little as $0 or much as $742 per day, depending on the length of your hospital stay. Part B coinsurance is 20 percent of all Medicare-approved health services after the deductible has been met.
Tips for choosing a Medicare Advantage plan
When looking for the best Medicare Advantage plan for your needs, consider the following:
- the type of coverage you need, which can influence what type of plan you choose and what type of plan offerings to look for
- the amount of provider flexibility you need, which can help you figure out what type of Advantage plan structure to enroll in
- the average monthly and yearly out-of-pocket costs you can handle, which include premiums, deductibles, copayments, coinsurance, prescription drug costs, and out-of-pocket maximums
- how often you need care and what type of care you require, which can help you enroll in a plan that meets your financial and medical needs
After you’ve considered all the factors that relate to your personal situation, you can use the find a Medicare plan tool to find the exact Medicare Advantage plan that will serve you best.
Anyone who is enrolled in Medicare Part A and Part B is eligible to enroll in Medicare Advantage.
In 2021, people with end stage renal disease (ESRD) are eligible to enroll in a broader range of Medicare Advantage plans due to a law passed by Congress. Before this law, most plans would not accept you or limit you to a Chronic Condition SNP (C-SNP) if you had a diagnosis of ESRD.
Once you are ready to enroll in a Medicare Advantage plan, you’ll need to pay close attention to the following deadlines:
|Type of enrollment||Enrollment period|
|initial enrollment||3 months before, the month during, and 3 months after you turn age 65|
|late enrollment||Jan. 1–Mar. 31 each year |
(if you missed your original enrollment)
|Medicare Advantage enrollment||Apr. 1–Jun. 30 each year |
(if you delayed your Part B enrollment)
|open enrollment||Oct. 15–Dec. 7 each year |
(if you want to change your plan)
|special enrollment||a period of 8 months for those who qualify due to a qualifying life event, such as marriage, divorce, moving, etc.|
Most major insurance companies around the United States sells Medicare Advantage plans. Medicare Part C plan offerings are not standardized and differ from state to state and between companies.
When you enroll in Medicare Advantage, you can expect to pay all the original Medicare costs plus any Medicare Advantage plan costs.
Before you enroll in Medicare Part C, be sure to review your own personal situation to choose the best option for your long-term financial and medical needs.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.
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