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How Do Medicare Advantage Plans Work

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How Much Do Medicare Advantage Plans Cost

Medicare Advantage Plans Explained (2022)

Here are some costs you may need to pay if you choose a Medicare Advantage plan:

  • Part B premium. Even if youre enrolled in Medicare Advantage, youre still responsible for paying the Part B premium. This amount can cost up to $170.10 per month. However, some Advantage plans cover a portion or even all of this premium cost.
  • Coinsurance and copayments. Most Medicare Advantage plans charge a copayment or coinsurance amount for services rendered. These services could include a doctors office visit, specialists office visit, or even a prescription drug refill. Specific coinsurance and copayment amounts are set by the plan youre enrolled in.
  • MedicareAdvantage plan costs. Medicare Advantage plans can charge a monthly premium thats separate from the Part B premium. Other Advantage plans may be premium-free. In addition, Advantage plans can charge separate drug and health plan deductibles.

Individual healthcare needs play a huge role in how much you may end up paying out of pocket for your Medicare Advantage plan. For example, your plan costs can be affected by:

  • how often you seek services
  • whether you visit out-of-network providers
  • if you enroll in extra benefits

Original Medicare eligibility includes individuals who:

  • are 65 years old or over
  • have been receiving Social Security or Railroad Retirement Board disability benefits for 24 months

Medicare beneficiaries who are already enrolled in Medicare Part A and Part B are eligible to enroll in a Medicare Advantage plan.

Premiums Paid By Medicare Advantage Enrollees Have Declined Since 2015

In 2022, the average enrollment weighted MA-PD premium, including among those who do not pay a premium, is $18 per month. However, average MA-PD premiums vary by plan type, ranging from $16 per month for HMOs to $20 per month for local PPOs and $49 per month for regional PPOs. Nearly 6 in 10 Medicare Advantage enrollees are in HMOs , 38% are in local PPOs, and 3% are in regional PPOs in 2022. Regional PPOs were established to provide rural beneficiaries with greater access to Medicare Advantage plans.

Average MA-PD premiums have declined from $36 per month in 2015 to $18 per month in 2022. The reduction is driven in part by the decline in premiums for local PPOs and HMOs, that account for a rising share of enrollment over this time period. Since 2015, a rising share of plans are bidding below the benchmark, which enables them to offer coverage without charging an additional premium. More plans are bidding below the benchmark partly because Medicare Advantage benchmarks relative to traditional Medicare have increased over time, and when benchmarks increase, plans are able to keep more for Part A and B services as well as for extra benefits. Further, rebates paid to plans have increased over time, and plans are allocating some of those rebate dollars to lower the part D portion of the MA-PD premium. Together, these trends contribute to greater availability of zero-premium plans, which brings down average premiums.

How Do Medicare Advantage Plans Work

A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

These “bundled” plans include

, and usually Medicare drug coverage .

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Open Enrollment: How To Enroll In Medicare Advantage

During the open enrollment period, which runs from October 15 to December 7 each year, you can join, switch or drop a plan for your coverage to begin on January 1 of the following year.

If youre already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or Original Medicare during the Medicare Advantage open enrollment period, which starts on January 1 and ends on March 31 annually. You can only make one switch during that time period.

If youre already enrolled in Original Medicare , you may be eligible to switch to a Medicare Advantage plan . You must be at least 65 years old or have certain disabilities, such as permanent kidney failure or amyotrophic lateral sclerosis . If the Medicare Advantage plan you choose doesnt already have prescription drug coverage, you will have the option to enroll in Part D.

Compare Top Medicare Plans From Major Carriers

To compare Medicare plans available in your area, click Compare Plans or call 888-349-0361 to speak with a licensed insurance agent.

Silver Sneakers Vs Active And Fit Direct Program

What is the Medicare Process? How does it work?

When it comes to fitness programs, beneficiaries have plenty of options. SilverSneakers and Active & Fit Direct are both fitness programs that accommodate seniors.

The SilverSneakers program allows beneficiaries to have free access to gyms nationwide.

Members may have access to full use of gym equipment and benefits, including weights, cardio machines, saunas, pools, and hot tubs.

SilverSneakers offers fitness classes such as yoga, cardio-fit, circuit training, and water aerobics.

The Active and Fit program allows members to choose from over 9,000 facilities across the nation.

The program offers an online directory map and locator for fitness facilities. Also, you can switch fitness centers to make sure you find the right fit.

The Active& Fit Direct Program also offers online wellness tracking, which comes from a variety of wearable fitness devices. However, the program is only for individual or employer group members.

Active& Fit Direct continues to expand its growing network to meet the clients needs. This year there was an addition over 1200 facilities, including large chains, independent and local gyms.

Members can search the online directory for some of the nations finest fitness centers in their area.

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How Can I Find A Silver Sneakers Near Me

Finding a Medicare Silver Sneakers gym near you is extremely simple using the following process.

Step 1: The easiest way to find silver sneakers near me if to go to the Silver Sneakers website and open its location search page.

Step 2: Enter your state, city, ZIP code or full address

Step 3: Choose the Medicare Silver Sneakers location of your choice

Consider Your Other Costs

Out-of-pocket costs can quickly build up over the year if you get sick. The Medicare Advantage Plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick. The best candidate for Medicare Advantage is someone who’s healthy,” says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. “We see trouble when someone gets sick.”

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How Do I Join A Medicare Advantage Plan

After enrolling in Original Medicare, you’ll be able to join a Medicare Advantage plan. Then, youll want to compare plans and see which one best fits your needs. Our guide explaining how to apply for an MA plan will help you figure that out.

Alternatively, if you would rather have an experienced agent help you find the best MA plan for your needs, call us.

Related topics:

How To Get A Medicare Advantage Plan

What is Medicare Advantage? Medicare Advantage Plans Explained (2021)

You typically have to meet three criteria to participate in an MA Plan:

  • Live in your chosen plan’s service area
  • Have Medicare Part A and Part B
  • Be a U.S. citizen or lawfully present in the U.S

If you meet these requirements, shop for Medicare Advantage Plans using Medicare’s Plan Finder. Enter your zip code and click “Medicare Advantage Plans” to view estimates of your Part B monthly premium and MA plan premium. From there, browse a list of plans in your area and drill down to their costs and features. Medicare also gives each plan a star rating that gauges its quality. The fewer the stars, the better off you are steering clear of that plan.

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Networks Are Not A Dealbreaker

One of the most controversial parts about Medicare Advantage plans compared to Original Medicare is that Advantage plans have network restrictions. This can be a massive turn-off for people who want the freedom to see whoever they please or to keep the doctor theyve had for years.

For others, its not that big of a deal. Not everyone has a problem with needing to switch doctors or pharmacies. Advantage plan networks are not all the same size either. Many people find themselves in an extensive network with plenty of options for healthcare providers that accept their plan if they need to find a specialist or change doctors.

Drug Coverage In Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage . You can join a separate Medicare drug plan with certain types of plans that:

  • Cant offer drug coverage
  • Choose not to offer drug coverage

Youll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

  • Youre in a Medicare Advantage HMO or PPO.
  • You join a separate Medicare drug plan.

Note:

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Question #: How Do I Find A Location Or Class And Can I Go To More Than One

To find participating fitness locations or classes in the SilverSneakers network near you, use our location tool, or download the SilverSneakers GO app .

We recommend that you check with locations directly to find out about their hours and class schedules.

And yes, you can go to any participating location or class you like in the SilverSneakers network, even if youre traveling.

For example, you can use weights or exercise machines at one location, swim in the pool at another location, and take a SilverSneakers or FLEX class at a third location.

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Do I Need A Medicare Rx Plan

Medicare Advantage Plans at age 65

Medicare Part B covers a limited number of outpatient prescription drugs under limited conditions. Drugs covered under Part B are drugs youd have administered in a doctorâs office or hospital outpatient setting, such as a flu vaccine. You can view a list of these drugs at Medicare.gov.

For medications youd administer yourself, including maintenance medications and drugs prescribed by a doctor to take at home, youd want to consider a Medicare Rx plan or a Medicare Advantage plan that includes prescription drug coverage.

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What Is Medicare Advantage

Medicare Advantage is a Medicare plan offered by private insurers who contract with the program. Medicare Advantage plans, also known as Medicare Part C, provide hospital, outpatient, and, usually, prescription drug coverage, supplanting benefits under Medicare parts A, B, and D.

Anyone who joins an MA plan still has Medicare, and must continue paying Medicare Part B premiums in addition to any charged by the plan. Medicare Advantage plans typically have lower out-of-pocket choice than traditional Medicare and may offer additional benefits, while requiring members to receive care from providers in their network, and to obtain referrals to see specialists.

Cobra Coverage From An Employer Plan

Federal and state law allows people who leave their jobs to continue their employer-sponsored health coverage for a period of time. Be aware of the following:

  • You have an eight-month period after your employment ends to enroll in Medicare. If you dont enroll during that eight-month window, you might have to pay a penalty when you enroll.
  • If youre in your Medicare initial enrollment period, you must enroll in Medicare during that time to avoid a possible penalty.
  • If you dont buy a Medicare supplement policy during your open enrollment period, youll be able to buy some Medicare supplement plans within 63 days of losing your COBRA coverage.

Talk to your employer about COBRA and Medicare eligibility.

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Do You Need Medicare Supplement

Not everyone needs a Medicare supplement policy. If you have other health coverage, the gaps might already be covered. You probably dont need Medicare supplement insurance if:

  • You have group health insurance through an employer or former employer, including government or military retiree plans.
  • You have a Medicare Advantage plan.
  • Medicaid or the Qualified Medicare Beneficiary Program pays your Medicare premiums and other out-of-pocket costs. QMB is a Medicare savings program that helps pay Medicare premiums, deductibles, copayments, and coinsurance.

If you have other health insurance, ask your insurance company or agent how it works with Medicare.

What Is Medicare Part C

How Do Medicare Advantage Plans Work? A Brief Overview

A Medicare Advantage Plan is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A and Part B coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage .

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services . These rules can change each year.

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How Original Medicare Works

Original Medicare does not include coverage for prescription drugs or routine dental, vision and hearing care. If you choose Original Medicare, you can pay for those things out of pocket, or you can purchase a stand-alone prescription drug plan and a Medicare Supplement plan to beef up your coverage. These added plans help , although youll pay a separate premium for each.

  • Medicare Part A helps cover inpatient hospital care, skilled nursing facilities, and some home health services. Most people who paid Medicare taxes while working dont have to pay a monthly premium for Part A.
  • Medicare Part B helps cover medical services, including doctors visits and many preventive services. The standard Part B premium for 2023 is $164.90 or higher, depending on your income.
  • Medicare Part D helps cover prescription drug costs. Costs for Part D depend on things like the plan you choose and what type of prescription drugs you require.
  • Medicare Supplement Medicare Supplement plans may help pay out-of-pocket costs not paid for by Medicare Parts A and B, including copays, deductibles and coinsurance.*

Medicare Advantage Vs Original Medicare

Medicare Advantage plans may have provider networks that limit your choices. If you go outside the network, your care may not be covered or may cost significantly more than if you stay in-network. With Original Medicare, you generally can use any doctor or medical facility that accepts Medicare assignment.

In exchange for less freedom, though, you often pay less. You would still be required to pay a monthly premium for Part B, but the additional cost for a Medicare Advantage plan may be less than for a Medigap plan. Sometimes the Medicare Advantage plan may have a $0 premium.

Medicare Advantage plans may also have a maximum out-of-pocket limit for covered care. That caps the amount youll be expected to pay in addition to your premiums. That cap is $8,300 in 2023.

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Choosing Between A Ppo Or Hmo Plan

When choosing between a Medicare HMO or PPO, there are several factors to consider.

First is your current need for care and the complexity of this care. Next is your predicted budget for healthcare services, along with your current income. Finally, its worth considering the stability of your current situation. For example, if you regularly travel for work or have plans to move soon, this may affect your decision.

Consider a family with two young children. All family members are healthy, and doctors visits are infrequent. Theyre established in their current neighborhood, but one of the parents has recently lost their job. In this case, an HMO Medicare Advantage plan may be a good choice. A large number of network providers helps keep overall costs down. At the same time, the familys plan to stay in the local area lowers the chances of going outside this network, reducing unexpected out-of-pocket costs. Lower-cost HMO premiums combined with small or no deductibles help keep spending under control.

Why Would Someone Choose A Medicare Advantage Plan

Medicare Advantage

January 9, 2023 By Danielle Kunkle Roberts

When it comes to Medicare, you have two options for cost-sharing help with your medical expenses. A Medigap plan, also known as a Medicare Supplement, or Medicare Part C, more widely known as Medicare Advantage. Medicare Advantage is an alternative to Medicare and has become quite controversial in the Medicare world. Still, almost 30 million people across the nation choose a Medicare Advantage plan for coverage.

Like most things, Medicare Advantage plans have many pros and cons. And if you turn on the TV, you know there are a ton of commercials claiming they offer all these extra benefits.

It can be hard to separate facts from all the misinformation out there, making choosing a plan even more confusing and overwhelming. In our , my team is frequently asked why someone would choose a Medicare Advantage plan after so many others recommend a Medicare Supplement plan. Well, I want to clear the air and discuss some key points youll want to consider when choosing a plan.

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Covered Services In Medicare Advantage Plans

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs and some vision, hearing, and dental services . Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations. Learn more about what Medicare Advantage Plans cover.

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