Medicare Advantage

What Is Medicare Advantage?

Medicare Advantage is also called Part C. It's another way to get your Medicare. Private insurance companies run these plans, and Medicare approves them. Instead of getting your hospital and medical coverage directly from Medicare, you get it through a private plan.

Most Medicare Advantage plans cover your drugs too. Many add things Original Medicare skips, like dental, vision, hearing, and fitness memberships. The specific benefits and costs vary significantly by plan and location.

Types of Medicare Advantage Plans

• HMO: You use the plan's list of doctors. You'll need a referral to see a specialist. These usually cost the least.
• PPO: You can see doctors outside the network. It usually costs you more.
• PFFS (Private Fee-for-Service): Sets its own payment terms. Any Medicare-approved provider who agrees to the plan's terms can see you.
• SNP: Built for certain groups. D-SNP is for people with Medicare and Medicaid. C-SNP is for people with a long-term illness.

What Does Medicare Advantage Cost?

Costs vary widely by plan. Some plans have $0 monthly premiums, but you still pay your Part B premium to Medicare. Plans have an annual out-of-pocket maximum, which limits your total exposure in a given year. Original Medicare has no out-of-pocket cap.

Who Is Medicare Advantage Best For?

Medicare Advantage tends to work well for people who:

• Are generally healthy and don't use a lot of medical services
• Want bundled coverage (medical + drug + dental/vision in one plan)
• Are comfortable using a network of providers
• Live in an area with good plan options (metro Idaho has solid selection)

Enrollment Periods

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday
• Annual Enrollment Period (AEP): October 15 through December 7 each year
• Open Enrollment Period (OEP): January 1 through March 31 (switch from MA to Original Medicare)