Medicare Advantage plans, also known as Part C coverage, allow you to get Medicare coverage from private insurance companies in contract with the Federal government. All Medicare Advantage plans often provide the same benefits as original Medicare but may have different regulations, coverage exclusions, and rates. If you are about to enroll in a Medicare Advantage plan for the first time, you may have several questions about its cost, services covered, etc.
Here we have answered some of your questions about Medicare Advantage plans.
1. What Does Medicare Advantage Plan Cover?
A Medicare Advantage plan covers all original Medicare benefits, such as Part A (hospital expenses) and Part B (medical supplies and equipment). In addition, Medicare Advantage plans may cover hearing, vision, and dental care and other health and wellness programs.
2. Can I Get Care from the Preferred Doctor?
It depends on the type of Medicare Advantage plan you choose. There are four types of Medicare Advantage plans, including:
- Health Maintenance Organization (HMO) Plans – With these plans, you must receive care from the doctors in the network, except for emergency care and out-of-area dialysis and urgent care.
- Preferred Provider Organization (PPO) Plans – These plans allow you to receive care from doctors or hospitals in or out–of–network.
- Private Fee-for-Service (PFFS) Plans – These plans also allow you to receive care from doctors or hospitals in or out–of–network.
- Special Needs Plans (SNP) – With these plans, you must receive care from the doctors in the network, except if you have end-stage renal disease or need out-of-area dialysis or urgent/emergency care.
Though some plans allow you to see out-of-network providers, visiting network providers or hospitals costs less.
3. Does Medicare Advantage Plan Cover Prescription Drugs?
Yes, Medicare Advantage Plan includes Part D Coverage that pays for your prescription drugs. However, prescription drug coverage has a formulary, which consists of the list of medications covered under the plan. If your medicine is not listed in the formulary, you may have to file an appeal, request an exception, or pay out of pocket.
4. What Is the Plan’s Star Rating?
Every year, the Centers for Medicare & Medicaid Services assess the quality of Medicare Advantage plans and provide ratings accordingly. A plan with a 5-Star rating means the best. These ratings are easy to compare plans and finalize the better one. You can find the latest ratings for all Medicare Advantage plans on the official site of Medicare.
5. What Is the Right Medicare Advantage Plan to Go with?
The right Medicare Advantage plan depends on your healthcare needs, the providers you want to see, and your budget.
However, generally, while choosing between the Medicare Advantage plans, ensure the:
- Doctors and hospitals you prefer included in the plan’s network
- Plan’s cost suits your budget
- Prescription drug coverage includes the medicines you need now or in the future
- Plan has a good star rating
Now, you know some useful insights on Medicare Advantage plan, so that you can choose the best yet affordable plan for your needs.