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Medicare Advantage Plans

Medicare Advantage Plans
Medicare Advantage

What is Medicare Advantage?

Medicare Advantage Prescription Drug plan may combine Part A coverage, Part B coverage and Part D prescription drug coverage in one plan. These plans are offered by private companies approved by Medicare.

Medicare Advantage Plans differer based on the insurer and its plan offerings. Variable include out-of-pocket costs, required referrals to see specialists and provider networks.

Types of Medicare Advantage Plans include the following:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNP)
  • Medical Savings Account (MSA) Plans
Medicare Advantage Plans - North Carolina
Medicare Advantage Plans - North Carolina

Most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Typically you get prescription drug coverage (Part D) through the plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan.


Common Questions about Medicare Part D

Frequently Asked Questions

Medicare Advantage Plans, also known as Part C, are an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare and provide all Part A and Part B benefits. Many Medicare Advantage Plans also offer additional benefits such as dental, vision, hearing, and prescription drug coverage (Part D).

You can enroll in a Medicare Advantage Plan during your Initial Enrollment Period (IEP), which is the seven-month period around your 65th birthday. Additionally, you can enroll or make changes to your plan during the Annual Enrollment Period (AEP) from October 15 to December 7 each year. If you qualify for a Special Enrollment Period (SEP), such as moving to a new area or losing other coverage, you can also enroll or switch plans at that time.

The main difference between Medicare Advantage Plans and Original Medicare is that Medicare Advantage Plans are offered by private insurance companies and often include additional benefits not covered by Original Medicare, such as dental, vision, and prescription drug coverage. Medicare Advantage Plans typically require you to use a network of doctors and hospitals, whereas Original Medicare allows you to see any doctor or hospital that accepts Medicare.

The costs associated with Medicare Advantage Plans can include a monthly premium (in addition to your Part B premium), copayments, coinsurance, and deductibles. The exact costs vary depending on the plan you choose. Some Medicare Advantage Plans have low or even $0 premiums, but out-of-pocket costs can vary based on the services you use and whether you see in-network or out-of-network providers.

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