Medicare is made up of four parts: Part A, Part B, Part C and Part D. Medicare Advantage is simply another term for Part C.
Part A and Part B are known together as “Original Medicare.” Medicare Advantage plans (Part C) are an alternative to Original Medicare. In other words, if Part A and Part B together don’t fully meet your needs, Medicare Advantage may.
Medicare Advantage plans must cover all of the same services that Original Medicare does. The only exception is hospice care, which is still covered by Medicare Part A. Medicare Advantage plans may offer some additional coverage such as vision, hearing, dental and prescription drug coverage — services that aren’t typically covered by Part A and Part B.
Medicare Part A and Part B originated in 1965 (hence the name “Original” Medicare). Medicare continued to evolve throughout the years as more coverage areas, options and demographics were added or changed.
The Balanced Budget Act of 1997 introduced “Medicare+Choice,” and that name was later changed to Medicare Advantage following the 2003 Medicare Modernization Act. The goal of introducing Part C was to provide patients with more options and flexibility for their Medicare coverage.
Original Medicare is administered by the federal government. Medicare beneficiaries pay standardized premiums, deductibles, coinsurance and other costs.
Medicare Advantage is different. Medicare contracts with private insurance companies to offer private health plans. You receive your benefits from the private health plan instead of the government.
Medicare Advantage is a collection of thousands of individual plans. Medicare Advantage plans can differ greatly in price according to benefits, location, carrier and more.
Like traditional health insurance, Medicare Advantage plans employ different health care delivery models. The most prevalent are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
Because there are so many different plans offered by many different insurance companies, the costs associated with Medicare Advantage plans may vary. Some of the factors that can influence the cost of a plan include:
In 2019, the average monthly premium for a Medicare Advantage plan that includes prescription drug coverage (MA-PD) will be $40, according to the Kaiser Family Foundation.** Keep in mind that you pay the Medicare Part B premium in addition to your plan’s premiums.
In 2018, 34% of all people enrolled in Medicare were enrolled in a Medicare Advantage plan.
Some Medicare Advantage plans come with a $0 monthly premium, though $0 premium plans may not be available in all locations. Some plans may even help you pay for your Part B premium.
Finding the right Medicare Advantage plan for your needs involves shopping around. It also helps to speak with a licensed insurance agent who can help you navigate your options.
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** Kaiser Family Foundation, “Medicare Advantage 2019 Spotlight: First Look,” Published October 16, 2018. https://www.kff.org/report-section/medicare-advantage-2019-spotlight-first-look-data-note
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