MEDICARE ADVANTAGE PART C
Talk To Us
- Have Original Medicare Part A and Part B.
- Live in the plan’s service area.
- Be a United States citizen or lawfully present in the United States.
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private-Fee-for-Service Plans), you can join a separate Medicare drug plan. However, if you join a Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization Plan (PPO) which doesn’t cover drugs, you can’t join a separate Medicare drug plan.
What does a Medicare Advantage plan cost?
- Most Medicare Advantage plans have low to $0 premiums.
- But you must continue to pay your Original Medicare Part B premium ($170.10 in 2022) and Part A premium (if you do not have a premium-free Part A).
- Medicare Advantage plans, only cover one person. Spouses need a separate plan.
- There are typically copayments or coinsurance for each visit or service, but it cannot be more than what Original Medicare would charge.
- Medicare Advantage plans have networks and if you go outside those networks, except in an emergency, you may have to pay more or not be covered at all.
- Some plans offer extra benefits and there may be a cost associated with these benefits, such as copays for eyeglasses or hearing aids.
- Plans have a maximum out of pocket for medical services and may have a separate deductible for prescription drugs depending on the type of drug and what Tier category it falls in.
- You can ask your plan, in advance if it covers a service, drug or supply. This is called an “organization determination”. If your plan denies coverage, you have the right to appeal.
- If the plan provider refers you to a provider outside the network without getting an organization determination first, this is call “plan directed care” and in most cases, you won’t have to pay more than the plan’s usual cost sharing.