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How do Medicare Advantage plans work?

Introduction

Medicare Advantage plans are part of Original Medicare, the federal government-run health insurance program that consists of Part A and Part B. Medicare Advantage plans cover everything that Original Medicare does, but some plans may cover more. You can use your plan's network for most or all of your care. You'll pay a premium for your plan every month. You'll have a maximum amount you must pay out-of-pocket each year before the plan pays 100 percent of your covered expenses. The cost and coverage under Medicare Advantage plans can vary by state and the insurer.


Medicare Advantage plans are part of Original Medicare, the federal government-run health insurance program that consists of Part A and Part B.


Medicare Advantage plans are part of Original Medicare, the federal government-run health insurance program that consists of Part A and Part B.

Medicare Advantage plans are insurance policies that cover everything that Original Medicare does, but some plans may cover more. In general, you will use your plan's network for most or all of your care. If you need to go out-of-network for care, there will be a cost to you (but still within the limits set by law).


Medicare Advantage plans cover everything that Original Medicare does, but some plans may cover more.

Medicare Advantage plans cover everything that Original Medicare does, but some plans may cover more.

Medicare Advantage plans are run by private insurance companies and are an alternative to Original Medicare. The federal government pays the insurance company a monthly premium for each person enrolled in the plan, and in return, the company agrees to provide benefits similar to those offered under Original Medicare. So if a person has a Medicare Advantage plan, he or she will receive his/her Part A and Part B coverage from their insurer rather than directly from the government.

Some Medicare Advantage plans offer additional benefits that aren't included with regular health coverage such as dental care or vision services. These extra benefits can come with higher premiums so be sure you're comparing apples to apples when comparing plans!


You can use your plan's network for most or all of your care.


If you want to stick with your plan's network for most or all of your care, that's okay. You can use any provider in the network for major medical services and prescription drugs. This is one of the benefits of having Medicare Advantage—your health coverage will pay out-of-pocket costs for care at doctors, hospitals, and other providers in the plan's network. If you choose to go outside of the network, however, expect to pay more out-of-pocket than usual. Learn more.



You'll pay a premium for your plan every month.



Most Medicare Advantage plans have a monthly premium that you pay to the plan.

The premium is not based on your health, but rather on other factors such as the type of plan you choose and where you live.

Medicare Advantage plans can vary widely in price, coverage options, and features like extra benefits or prescription drug coverage. To compare costs and benefits across plans in your area:

  • Go to www.medicare.gov/find-a-plan/. Here you'll find information about all Medicare Advantage plans available to you in your state (or the U.S.). The website will also tell you how much each plan costs for different types of people (for example, what's the average monthly premium for a 65-year-old man living in Seattle?).

  • Once there, compare several different Medicare Advantage plans side by side using our comparison tool here: http://www.healthpocket.com/compare_plans/. This will help make sure that no matter which plans or combination of plans ends up being right for you at this time; it will be a good value because it provides solid coverage at an affordable price!

You'll have a maximum amount you must pay out-of-pocket each year before the plan pays 100 percent of your covered expenses.

You'll have a maximum amount you must pay out-of-pocket each year before the plan pays 100 percent of your covered expenses. This is called the out-of-pocket limit, and it's usually around $4,000. The exact dollar amount varies by plan, so check with your insurer to see the limit for their product.

If you want coverage that includes more than Medicare's minimum requirements (more on this later), this may mean paying more in premiums and having a higher deductible -- which would also take up some of your out-of-pocket maximum amounts. However, there are ways to get around this if you're willing to shell out even more money upfront. If you opt for a plan that covers specific drugs or providers (say one with extra vision coverage) but don't need those benefits immediately, then consider choosing one without as many bells and whistles as possible until they do become relevant to your life."


The cost and coverage under Medicare Advantage plans can vary by state and insurer.


One of the most important things to consider when choosing a Medicare Advantage plan is the cost. It's not just a matter of how much you'll pay every month, though—you also need to look at what that money covers, and whether any additional out-of-pocket expenses will apply. If you have an existing condition requiring treatment and medication, or if you're concerned about paying for over-the-counter medications like aspirin or cough drops, this becomes even more important.

There are other factors that can make certain plans better deals than others: some plans have better coverage than others when it comes to certain services (for example, some offer comprehensive vision coverage while others don't). In addition, some plans have restrictions on where you can get care (for example, they may limit access only to doctors who are enrolled in their network).


You may be able to save on prescription drugs or get added benefits with a Medicare Advantage plan.

When you have a Medicare Advantage plan, your health plan covers prescription drugs. But be sure to check the list of drugs covered by your plan. You may need to pay a copayment or coinsurance for some drugs. If you have Original Medicare with prescription drug coverage, your costs are lower than if you buy a stand-alone Part D plan (a private insurance policy). If your plan doesn't cover medication X, ask about getting it covered.


Conclusion

A Medicare Advantage plan can be a good option for you, but it’s important to do your research. The plan you choose will depend on the coverage and costs that are important to you and your family. If you’re unsure whether a Medicare Advantage plan is right for you, talk with your doctor or pharmacist about their experience with these plans and get more information about how they work before making any decisions about switching from Original Medicare.



Medicare is a federal program that provides healthcare coverage to individuals 65 years or older. Original Medicare coverage is broken into two parts - Part A and Part B - and is accepted by nearly every doctor and hospital in the country. Medicare Part A covers inpatient or hospital stays, while Part B covers outpatient or medical care. Parts A and B cover about 80% of seniors' typical healthcare costs. This leaves a few significant gaps in coverage. Medicare Supplement (Medigap) and Medicare Advantage plans are policies designed to help extend coverage, lessen expenses and ultimately give beneficiaries peace of mind. If you or someone you know would like more information about how to enroll in Original Medicare or one of the Medicare Advantage plans, call now to speak with a licensed agent (208) 818 2523. We cannot wait to help you learn about your options.

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