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Medicare Advantage Guides

Medicare Advantage is a type of plan that replaces Medicare Parts A & B. It’s offered by private insurance companies.

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Most Popular Questions About Medicare Advantage

Q: How Do Medicare Advantage Plans Work?

Medicare Advantage, also known as Medicare Part C, operates more like traditional health insurance than Original Medicare (Medicare Part A & Part B).

Enrolling in Medicare Part C/Medicare Advantage

To enroll in Medicare Advantage, you’ll have to choose a plan and sign up through a broker or insurer. Medicare Part C is offered by multiple private insurance companies. You can’t join a Medicare Advantage plan until you enroll in Original Medicare. If you decide to enroll in Medicare Part C, it will replace your Original Medicare coverage.

Once you enroll in Medicare Advantage, you’ll only interact with your insurer and their provider network. However, you’ll continue paying for Original Medicare, which the federal government will use to reimburse your Medicare Advantage insurer. Fortunately, your plan will help you consolidate these bills.

How Medicare Part C Works

Medicare Advantage plans work to cover all Original Medicare services and may offer additional benefits. Unlike Medicare Supplement plans, which are standardized no matter who sells them, private insurers can choose what their Part C plans offer. Insurers may define their own premiums, deductibles, copayments, and physician referral systems. Your Medicare Advantage plan will negotiate payments to doctors that may be higher than what they receive from Original Medicare. However, fewer doctors will be enrolled in your Medicare Advantage plan compared to Original Medicare.

Billing and Costs

Once you sign up for Part C, your billing and care may be consolidated. You can typically access all your medical services with just one card, choose a primary care physician, and pay for different treatments with a single bill.

The average Part C plan cost $31.40 per month in 2017. For a small additional premium, many Medicare Advantage plans cover prescription drug costs (replacing Medicare Part D coverage). Most Part C carriers have a zero-premium plan available, with higher copayments or fewer additional benefits.

Taking the Next Steps

You only need to enroll in Part C one time. We recommend visiting our Medicare Advantage comparison tool, or asking us to connect you with a local broker who can offer a free, no-obligation quote.

Q: Does Medicare Cover Nursing Home Care?

Medicare coverage for nursing homes is essentially nonexistent; Medicare usually does not cover nursing home costs. Nursing homes are considered to be custodial care, not medical necessities. Medicare only covers hospital and medical bills – things that it considers medically necessary.

The exception for Medicare is the Part A skilled nursing benefit, which provides 24/7 in-patient care after a hospitalization for up to 100 days. Skilled nursing facilities help patients after an injury – they’re not nursing homes in the sense that nursing homes are often a designated place for the care of aging seniors.

Nursing home coverage is best provided by long-term care insurance, purchased well in advance of the recipient needing nursing home coverage. Otherwise, he/she might not meet underwriting and will be paying a substantial premium for meager coverage. If a senior needs to move to a nursing home and cannot afford care, Medicaid is also an option to look into.

Taking the Next Steps

Learn more about Medicare coverage at Some Medicare Advantage plans may also include a long-term care component.

Q: Can I Have Both Medigap and Medicare Advantage?

It is against the law for anyone to knowingly sell you a Medicare Supplement (Medigap) policy if you plan to stay on Medicare Advantage, and vice versa. You don’t need Medicare Advantage if you already have Medicare Supplement. Each type of plan covers many of the same things, so you’d be wasting your money. This means that you can’t have both Medigap and Medicare Advantage at the same time.

Medigap VS Medicare Advantage

Medicare Supplement plans are meant to fill your coverage gaps not paid for by Original Medicare (the government-run program also known as Medicare Part A and Part B). There are a number of blind spots in Original Medicare, any of which could burden seniors who lack supplementary coverage with significant out-of-pocket costs. Having a Medicare Supplement policy on top of Medicare Part A and Part B generally makes a lot of financial sense.

If you rely on Medicare Advantage coverage, you won’t need a Medicare Supplement plan. The two types of coverage aren’t even compatible, since each Medicare Advantage plan will have different cost-sharing rules than Original Medicare. Medicare Advantage plans operate similarly to what you’d find in traditional health insurance – they typically operate as an HMO, PPO or POS plan. Since Medicare Advantage’s provider network is more tightly managed than Original Medicare, Medicare Advantage plans can offer you insurance with fewer coverage gaps.

The rule against buying Medicare Supplement and Medicare Advantage at once protects Medicare beneficiaries from unknowingly buying something they don’t need.

Taking the Next Steps

For starters, don’t try to buy both types of supplementary coverage at once. Maybe compare each plan type and decide? Once you know what you want, we’d be delighted to give you a free, no-obligation Medicare Supplement or Medicare Advantage quote.

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