Medicare coverage can seem confusing, but it’s easier to understand your options if you’re familiar with every type of coverage, such as Medicare Advantage. Medicare Advantage plans are private health insurance plans sold by companies that have contracts with Medicare.

They’re an alternative to Original Medicare Parts A and B. Many Medicare Advantage options also include Part D.

But what does Medicare Advantage offer? And why should you consider it as you near age 65?

Private Companies Offer Medicare Advantage


In some ways, Medicare Advantage plans are similar to any other health insurance plan. You can choose the company from which you want to buy insurance as long as they offer Medicare Advantage plans.

The two main types of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The chief difference between them is that HMOs typically require beneficiaries to choose in-network providers, while PPOs allow patients to see out-of-network providers at a higher cost.

Unlike Medigap plans, which are also offered by private companies, Original Medicare doesn’t pay for services used under a Medicare Advantage plan. Instead, payment comes from the private company you’ve selected.

Man with dog. Medigap plan.

To take advantage of Medicare Advantage plans, you have to meet three basic criteria:

    You Must Meet Eligibility Requirements

  • You have Medicare Parts A and B
  • You live in the service area covered by the insurance company
  • You don’t have end-stage renal disease (ESRD)

As long as you satisfy those criteria, you can apply for Medicare Advantage.

The Coverage Is Comprehensive


One of the primary benefits of choosing Medicare Advantage over Original Medicare is that the coverage is often far more comprehensive. For one thing, MA plans often include Part D coverage, which pays for all or part of costs related to prescription drugs.

Medicare Advantage covers doctors’ visits, hospital stays, urgent care, emergency care, and more. If you have an MA plan, Original Medicare will still cover any hospice needs up to the plan’s limits.

Additionally, some Medicare Advantage plans also cover dental and vision care, which can decrease your out-of-pocket expenses.

What You Pay Can Vary Widely


Since Medicare Advantage plans are administered by private insurance companies, the coverage levels and monthly premiums can vary widely. So can the out-of-pocket expenses, such as deductibles, copayments, and coinsurance.

For instance, some plans cover all or part of your Medicare Part B premium. You might have separate deductibles for certain types of healthcare costs. A deductible is the amount of money you must pay out-of-pocket before the insurance begins to pay for services.

Your copayment is the amount of money, if any, you must pay providers at the time of service. Common copayments range from $10 to $40 per visit.

Some plans might require you to get a referral from your general practitioner or family doctor before you see a specialist. This is especially true for HMOs. You might also find Medicare Advantage plans that offer additional services, whether for free or at extra cost.

If you’re interested in gaining comprehensive health insurance coverage after you turn 65, consider Medicare Advantage. You can compare different plan options to find one that fits your specific needs. Alternatively, consider a Medicare Supplement plan, which could offer even more flexibility.

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