Medicare Advantage Plans, also known as Medicare Part C or MA Plans, are an alternative coverage option to Original Medicare Parts A and B.
These plans do not supplement Original Medicare. They are health plans offered by Medicare-approved private companies that must follow rules set by Medicare. Medicare pays a fixed amount each month to the company offering that plan for coverage of each beneficiary enrolled. These plans offer coverage for Medicare Part A and Part B services, and some plans may offer coverage for things Original Medicare doesn’t cover (such as routine dental or vision services, hearing aids, wellness programs, etc.). These plans may or may not include a Medicare Part D Prescription Drug Plan.
Medicare Advantage Plan Considerations
Medicare beneficiaries considering enrolling in a Medicare Advantage Plan should understand the costs associated with that plan, as each plan’s cost structure may differ from Original Medicare.
Medicare Advantage Plans have yearly contracts with Medicare. Each year, the plans set the amount they charge for premiums, deductibles, and covered service copayments/coinsurance. Plans must notify current members by sending out an Annual Notice of Change (ANOC) in September, before the start of the Annual (Fall Open) Enrollment Period for the coming year.
In many cases, the beneficiary needs to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what the out-of-pocket costs are each year for covered services, which helps the beneficiary to plan their budgets. Some plans offer out-of-network coverage, but sometimes at a higher cost. Providers can join or leave a plan’s provider network at any time. The plan can also change the providers in its network at any time. A new provider may need to be selected if either of these situations occurs.
The best way to get all the facts regarding any plan is to review the plan’s Evidence of Coverage. This plan document describes in detail the plan’s benefits, how much the beneficiary will pay, and how the plan works (including networks, coverage limits, prior authorization rules, etc.).
CAUTION: Television and Print Advertising/Marketing of Medicare Insurance Options
In general, the purpose of ads for Medicare insurance products is the solicitation of insurance. Meaning, they are trying to get the beneficiary to take action, to call the number on the screen (or the number on the card/letter). While the information presented in these ads about costs and benefits is required to be true, they likely do not include all the information a beneficiary needs to make an informed insurance choice. Beneficiaries are encouraged to go beyond the advertisements to get the facts about the insurance options available to them.
A publication from the Wisconsin Office of the Commissioner of Insurance (OCI) designed to provide an overview of Medicare Advantage in Wisconsin.