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Medicare Advantage, also known as Medicare Part C, is a plan provided by private insurance companies with the help from subsidies provided by the government so that the insurance company can design network based plans at a low or zero premium.
These plans are normally designed with copays and coinsurance throughout the plans as a form of cost share that the client would assume when joining one of these plans.
3 things to know about Medicare Advantage plans:
1. They are also known as Medicare Part C.
2. They are an alternative way to get Medicare coverage through private insurance companies instead of the federal government.
3. They provide the same benefits as Original Medicare and may include additional benefits such as dental, vision, prescription drug and wellness programs coverage.
Medicare Advantage plans are widely used in the United States. In 2022, more than 26 million people are enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation (KFF).1
So let's take a closer look at Medicare Avantage Plans.
Medicare Advantage Upsides:
1. It’s convenient to have a single plan for everything
2. The plan covers everything traditional Medicare covers (hospital insurance and medical insurance) as well as emergency and urgent care
3. Many plans also cover dental care, eyeglasses, and wellness programs
4. Most plans also include prescription drug coverage
5. Your eligibility isn’t affected by health or financial status
6. Premiums are low
Medicare Advantage Downsides:
1. You’re restricted to certain doctors in your network (unless it’s an emergency)
2. Plan premiums can change from year to year
3. Difficult to switch to Medigap later on
4. Plan benefits can change from year to year
5. You’re subject to high deductibles and co-pays that tend to range from $3,400-$6,700
What does Medicare Part C cover?
All Medicare Advantage plans include the same standard benefits as Medicare Part A and Part B.
•Medicare Part A benefits include coverage for inpatient hospital stays, hospice care for those with a terminal illness, skilled nursing facility care and some home health care.
•Medicare Part B benefits include coverage for diagnostic services, routine doctor services, outpatient care, medical equipment and other non-emergency medical care.
Most Medicare Advantage plans also provide prescription drug coverage.
Some Part C plans may also cover benefits such as:
1. Routine dental and vision care
2. Hearing care and allowances for hearing aids
3. Health and wellness club memberships
Some Medicare Advantage plans may also cover services such as non-emergency medical transportation, home health care and home modifications such as bathroom grab bars.
Some types of plans restrict your coverage to in-network health care providers. Individual plan benefits and availability can vary depending on where you live and the type of Part C plan you have. Not all of these extra benefits will be available with Medicare Advantage plans in all areas.
Medicare Advantage plan benefits can change from year to year, so it's important to check with your plan each year to make sure it is still the best Medicare Advantage plan for your unique needs.
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