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 in a Medicare Advantage plan, and what to expect from the companies that offer Medicare Advantage plans.
Medicare Advantage, also known as Medicare Part C, is Medicare coverage that private insurance companies sell. In addition to covering Medicare parts A and B, most Advantage plans also cover prescription drugs, and dental, vision, and hearing services. Some Medicare Part C plans even cover health perks like fitness memberships and certain home health services.
What most Medicare Advantage plans cover:
- hospital services
- medical services
- prescription drugs
- dental, vision, and hearing
- additional health perks
Medicare Advantage plans are a great option for people who want additional coverage beyond Medicare parts A and B, such as prescription drugs and yearly health checkups. 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
- United American
Medicare Part C offerings vary from state to state, and each insurance company has the right to decide whether they will sell Advantage plans. For example, some companies may offer Advantage plans in one state, but decide not to sell those plans in another state. 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, you can reach out and ask if they sell Medicare Advantage plans. However, if you want to review all of your plan offerings, Medicare.gov has a “Find a Medicare plan” tool that anyone can access. 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 so many factors that can affect what you will pay. All these costs are influenced by the state you live in, the cost of living, your income, where you go for 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 when you enroll in an Advantage plan:
- Premiums. If you are not eligible for premium-free Part A, your Part A premium can cost up to $458 per month. The Part B premium costs $144.60 per month or more, depending on your income. Some 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 $1,408 per benefits period. Part B has a deductible amount of $198 per year. If your 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 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 $704 or more per benefits period, 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 the best Advantage Plan for you
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 – with the exception of people who have end stage renal disease (ESRD).
Once you are ready to enroll in an Advantage plan, you’ll need to pay close attention to the following deadlines:
|Type of enrollment||Enrollment period|
|Original enrollment period||3 months before, the month during, and 3 months after you turn 65|
|Late enrollment period||Jan. 1 through March 31 each year |
(if you missed your original enrollment)
|Medicare Advantage enrollment period||April 1 through June 30 each year |
(if you delayed your Part B enrollment)
|Plan change enrollment period||October 15 through December 7 each year |
(if you want to change your plan)
|Special enrollment period||a period of 8 months for those who qualify|
Keep in mind that if you miss the original enrollment period around your 65th birthday and you choose to enroll in an Advantage Plan later, you may risk late-enrollment penalties.
Most major insurance companies around the United States offer Medicare Advantage plans for sale. 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 Advantage plan costs. Before you enroll in Medicare Part C, be sure to review your own personal situation in order to choose the best option for your long-term financial and medical needs.