Medicare is a massive government health insurance program for American seniors, which currently provides health insurance for more than 55 million people.
Eligibility is simple: You must be age 65 or older, a U.S. citizen or legal resident living in the U.S. for at least five straight years before applying, and you or your spouse would have needed to pay Medicare taxes during your working years.
Medicare also has four main parts: Part A, or hospital insurance; Part B, or medical insurance; and Part D, which is prescription drug coverage.
Medicare Part C is the fourth main component, and is known as Medicare Advantage.
Medicare Advantage is an alternative to “Original Medicare,” or Parts A and B. It allows program beneficiaries to receive their Medicare benefits through a private health insurance plan, and private health insurance carriers to receive payments from the Medicare program to cover beneficiaries’ medical costs.
One of the main attractions to Medicare Advantage is that it offers plans with more coverage options than Original Medicare. At a minimum, every Part C plan must include Part A and B equivalent hospital and medical services, but they usually include other items such as prescription drug coverage, dental and vision.
About 19 million Medicare participants are currently enrolled in Medicare Advantage, or about one in three Medicare enrollees. Different forms of Medicare Advantage plans include:
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Private Fee-for-Service (PFFS)
Special Needs Plans (SNPs)
Medical Savings Account (MSA)
Although Medicare Part A is free, and Part B coverage carries about a $130 monthly premium (for 2018), Medicare Advantage plans require additional costs.
First, to be eligible for Medicare Advantage, you have to be enrolled in Part A and B, which means you’ll pay the Part B monthly premium in addition to your Medicare Advantage monthly premium — even if you’re enrolled in a so-called “zero premium” plan. Medicare Advantage enrollees are also confined to their private plan’s provider network, rather than having access to Part A and B doctors and hospitals across the country.
If Medicare Advantage is right for you, you can enroll during your initial seven-month enrollment period beginning three months prior to your 65th birthday month, during Medicare’s annual Open Enrollment Period from October 15 through December 7, or during the Medicare Advantage new specific enrollment period which you can learn more about on the Medicare website.
We know this article may raise more questions that it answers. Do not wait to let us know how we can help you as you plan for yourself and your senior loved ones.