Medicare Advantage Insurance

2014 Medicare and Medigap Updates

Medicare Advantage Insurance

Medicare advantage insurance is one of the two main options under Medicare. The other option is Original Medicare. Medicare advantage is also known as Medicare Part C or MA plans. This insurance is required by federal law to, at a minimum; cover all the medical costs Medicare Part A and Part B cover. Basically, this means that Medicare advantage insurance is made up of both Medicare Part A and Part B. On top of the combined coverage of parts A and B, these advantage plans also provide prescription drug coverage, which is Medicare Part D.

In addition to providing coverage like Medicare Part A, B and D combined, the Medicare advantage insurance plans may offer additional coverage for things Original Medicare does not cover. These include dental care, vision care and eye glasses, hearing care, emergency treatment abroad and so on.

Medicare advantage insurance is provided by private insurance companies contracted by the Center for Medicare and Medicaid Sevices (CMS) which is part of the DHHS (Department of Human Health Services) to provide this coverage. These private insurance companies are referred to as MAOs (Medicare advantage organizations). CMS is responsible for ensuring that these private insurance companies are compliant and providing the required services to their beneficiaries.

Medicare pays a monthly fixed amount of money to the MAOs so that these organizations can provide some extra benefits to their enrollees. However, Medicare advantage insurance plans will more often than not limit the choices of their enrollees regarding hospitals, physicians, other health providers. For instance, you will need a referral from your primary care physician to see a specialist.

Even though Medicare advantage insurance plans are supposed to provide the coverage that Medicare Part A and Part B provide, they are not required to provide them in the exact same way as the Medicare parts A and B. These plans can also charge a premium for the plans or other out of pocket costs such as co-payment, co-insurance and deductibles.

To join a Medicare advantage insurance plan, you must already have Medicare Part A and part B. This means you either have to be 65 years and above or qualify for Medicare due to disability or qualifying conditions such as Lou Gehrig’s disease or end stage renal disease. However, if you qualify for Medicare due to disability and are receiving Social Security Disability Insurance (SSDI) payments, you can only join such a plan during the period between the 22nd month of your disability to the 28th month.

The Medicare advantage plans vary greatly as they are not standardized like the Medigap plans. Factors such as the state in which you live, the rules of the advantage plan, the premium paid and so on will affect the kind of plan you get.

Before obtaining Medicare Advantage insurance, you may want to check on a Medigap policy. Medigap is a Medicare supplement policy that is government regulated and low cost. You may find Medigap cost is sometimes less than Medicare Advantage.