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Medicare Advantage Questions

Medicare is the federally funded health insurance program for Americans over age 65 and those with certain disabilities. The program came into existence in 1965, as part of President Lyndon B. Johnson's "Great Society" program, along with Medicaid. In its modern form, according to the Medicare website, it consists of four parts: Part A covers hospital charges; Part B covers physicians charges, diagnostic procedures and medical equipment; Part C, Medicare Advantage, provides access to managed care organizations; and Part D covers prescription drugs.

  1. What Is Medicare Advantage?

    • Medicare Advantage is a way to control Medicare costs by applying best practices from the private health insurance industry to administering Medicare benefits. When you join Medicare Advantage, you select from a list of health maintenance organizations, preferred provider organizations, private fee-for-service plans and special-needs plans from companies operating in your area.

    Am I Eligible?

    • To enroll in Medicare Advantage, you must first be enrolled in Medicare Part A and Part B. You are enrolled in these plans automatically when you apply for Social Security benefits at age 65 or older.

    What Does Medicare Advantage Cover?

    • Specific plans vary by region and by company, but emergency and urgent care are always covered. Some plans provide coverage for vision, hearing, dental and general health maintenance programs, and most also include prescription drug coverage as well.

    Is It Free?

    • No. You must pay a premium to receive benefits under Medicare Part C, Medicare Advantage. That premium varies depending on the Medicare Advantage plan and provider you select. The cost also depends on which deductibles you select. Coinsurance and copay rules also can vary between companies and according to whether you use health care providers from in of out of the network.

    How Do I Find Plans In My Area?

    • You can find plans in your area by visiting the Medicare Plan Finder and filling in the requested information. You will get a thorough list of Medicare Advantage providers and Medicare Part D providers in your area. You can enroll in Medicare Advantage by contacting these providers directly.

    Do I Also Need Medigap Insurance?

    • No. Medigap insurance, or Medicare supplement insurance, does not work if you have Medicare Advantage. Medicare is the primary payer for health claims for its members --- Medigap plans will not pay deductibles or coinsurance if you have Medicare Advantage. Therefore, it typically does not make sense to pay for Medicare Advantage and Medigap/Medicare Supplement insurance at the same time.

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