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Medicare Advantage Plans

Medicare Advantage is a type of health plan that combines Parts A (hospital insurance) and Part B (medical insurance) of Original Medicare. These plans are offered by private insurance companies and have different coverage options, such as HMOs, PPOs, and health maintenance organizations (HMOs).

Medicare Advantage plans may also include prescription drug coverage (Part D). This means you do not need a separate Part D plan if you are enrolled in a Medicare Advantage plan with Part D.

Advantages

Additional benefits

Many Medicare Advantage plans offer additional benefits that are not covered by Original Medicare, such as vision, dental, and hearing coverage.

Lower out-of-pocket costs

Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare in certain cases. Here is how it works:

  • Medicare Advantage (Part C) plans are provided by private insurers and must cover at least the same services as Original Medicare (Parts A and B). However, MA plans often have additional benefits, such as out-of-pocket maximums, which Original Medicare does not offer.
  • Original Medicare does not have an out-of-pocket maximum, meaning there is no cap on how much you may need to spend in a year for covered services. You must pay deductibles, co-insurance, and 20% of the cost for most doctor services after you meet your Part B deductible.
  • Medicare Advantage plans usually have a set annual out-of-pocket limit for services covered under Parts A and B. Once you reach this limit, you do not have to pay for further covered services for the remainder of the year. This can provide more predictable costs and lower your financial risk in the long term.

However, not all Medicare Advantage plans have lower costs across the board, and sometimes they come with trade-offs such as more restricted networks or additional rules for accessing care. It is important for beneficiaries to compare plan options based on their healthcare needs.

Health and wellness programs

Many Medicare Advantage plans offer health and wellness programs, such as fitness classes and disease management programs.

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