Medicare Advantage

Medicare Advantage plans, commonly referred to as Part C, are offered by private health insurance companies which have been approved by Medicare to handle your Part A and Part B coverage. Medicare compensates these companies to take care of your hospital and medical insurance. Many plans come with added benefits not available under Original Medicare and can include prescription drug coverage, dental coverage, vision coverage, hearing coverage, and even health club memberships. You need to renew your plan contract each year, which gives you the opportunity to shop for the best coverage at a price that suits your budget. Our advisors have the tools to find you the coverage you need.

Medicare Advantage Eligibility

To be eligible for a Medicare Advantage plan, you must be enrolled in Original Medicare (Medicare Part A and Part B) and live within the Medicare Advantage plan’s service area. You must continue to pay your Part A and Part B premiums while on this plan, or you will be dropped from the plan and returned to Original Medicare.

Coverage Under Medicare Advantage

All Medicare Advantage plans give you the exact same coverage as under Part A and Part B. Additionally, many plans offer prescription drug coverage; these are often called MAPD plans (Medicare Advantage Prescription Drug). Plans with prescription drug coverage offer coverage equivalent to Medicare Part D prescription drug plans. Each plan gets to select which prescription drugs they will cover, as well as the pricing associated with each.

Medicare Advantage Costs

Monthly premiums will vary between plans, but these can be as little as $0 each month in addition to your Part A and Part B premiums (which you continue to pay directly to Medicare). Medicare Advantage plans often charge copayments, coinsurance, and deductibles, which also vary by plan. Choosing to see healthcare providers within your plan’s network will help to keep costs low.

Plans with prescription drug coverage will charge copayments for each drug, which you pay when you fill a prescription at the pharmacy. Covered drugs are sorted into tiers based on whether they are preferred or non-preferred as well as whether they are generic, brand-name, or specialty (requiring special handling or administration). Generic, preferred drugs will have the lowest required copayment and specialty drugs will have the highest copayments. You may have a separate deductible for your prescription drug coverage.

If you opt for additional packages for dental, vision, or hearing coverage, you will likely have to pay slightly higher monthly premiums or additional premiums for these benefits.

Enrolling in Medicare Advantage

To enroll in a Medicare Advantage plan, you can sign up during your Initial Enrollment period for Medicare when you first become eligible. If you are enrolled in Original Medicare and would like to switch to a Medicare Advantage plan, you can do so during Open Enrollment, which is from October 15 to December 7 each year. You can join, switch, or drop a plan during this time.

If you are already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare from January 1 to March 31.

If you have any questions about finding the right coverage, reach out to your Virginia Medicare advisors today at 540-404-3098.