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What does Medicare Advantage (Part C) cover?
- Same coverage as Original Medicare (known as Parts A & B) Note: you must first be enrolled in Original Medicare to be covered by Medicare Advantage
- Most Medicare Advantage plans also provide:
- Prescription drug coverage
- Routine dental and vision care
- Hearing care and allowances for hearing aids
- May also cover cost of non-emergency transportation, home health care, telehealth and other preventive modifications plus wellness programs with fitness benefits like exercise classes
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Newly eligible for Medicare? Call us at (888) 928-1456 TTY 711 or speak with a licensed sales agent near you. Hours of Operation
How much does Medicare Advantage (Part C) cost?
Costs of Medicare Advantage plans are not standardized so what you pay will depend on several factors including the plan specifics, the provider and where you live. Some Medicare Advantage plans feature $0 premiums, but those plans aren't available in all locations.
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Premiums
A premium is the amount you pay every month for your health insurance. Some Medicare Advantage (Part C) plans have a $0 monthly premium. However, you still have to pay the Part B premium.
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Deductibles
A deductible is what you pay yearly for medical care and prescriptions before your health plan begins to share in the cost of covered services. Most Medicare Advantage (Part C) plans have both a plan deductible and a drug deductible. Some Medicare Advantage plans offer a $0 plan deductible.
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Copayments and coinsurance
Copayments are the costs you may owe for medical care like doctor’s visits. Coinsurance amounts are any percentage of services you must pay out of pocket (expenses not reimbursed by insurance) after your deductible has been met. If your plan charges a copayment for doctor’s office and specialist visits and you have a chronic health condition or make frequent office visits, your costs might add up quickly which is something to consider.
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Maximum on out-of-pocket costs (expenses not reimbursed by insurance) like copayments, coinsurance and deductibles
One plus of Medicare Advantage (Part C ) is that all of the plans have an out-of-pocket (expenses not reimbursed by insurance) maximum. This amount varies but can range from the low thousands to upward of $10,000+.
Once enrolled in a Medicare Advantage plan you may have to pay some or all of the following costs:
Do I need Medicare Advantage?
If you want certain benefits that aren’t covered by Original Medicare (Parts A & B) like routine vision care, dental, hearing aids or coverage for prescription drugs, you may want to consider a Medicare Advantage plan, many of which bundle options like these into one plan. Medicare Advantage also includes an annual out-of-pocket (expenses not reimbursed by insurance) spending limit on in-network expenses.
Am I eligible for Medicare Advantage?
To qualify for Medicare Advantage (Part C) you need to meet two main eligibility requirements:
- You must already be enrolled in Original Medicare (Part A & Part B)
- Medicare Advantage plans must be available in your area
When can I enroll in Medicare Advantage?
Below are some of the circumstances when you can enroll in a Medicare Advantage plan:
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65th Birthday
Initial Coverage Election Period (ICEP)
This begins three months before the month you turn 65, includes your birthday month and ends either the last day of the month before you enroll in Medicare Part B or the last day of your Initial Enrollment Period which is three months after you turn 65, whichever comes later. You may also enroll in a Medicare Advantage plan during this period if you are newly eligible because you have a disability and are under age 65. For this to occur, you must first qualify for Original Medicare.
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Oct 15 - Dec 7
Annual Enrollment Period (AEP)
From October 15 – December 7 each year you can join, switch, or drop a plan. Your coverage will begin on January 1 as long as the plan receives your request by December 7. You can also use the Annual Enrollment Period to disenroll from Medicare Advantage (Part C) and switch back to Original Medicare (Parts A & B).
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Jan 1 - Mar 31
Medicare Advantage Open Enrollment Period
This period runs between January 1 – March 31 and allows a one-time change to your current Medicare Advantage (Part C) plan by changing your policy to another or switching back to Original Medicare (Parts A & B). You cannot make any changes to your coverage unless you already have a Medicare Advantage (Part C) plan, so this time period is not to join a Medicare Advantage (Part C) plan for the first time.
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Qualifying Event.
Special Enrollment Period (SEP)
Also known as special circumstances, during this period you may change or enroll in a Medicare Advantage plan if you meet certain criteria including:
- Change of residence that isn’t in the service area of your current plan or offers different or new plan options in your new location.
- You live in, are moving into, or recently moved out of a nursing home or long-term care facility.
- You’ve moved back to the U.S. after living outside of the country.
- You’ve been released from jail.
- You lose your current coverage.
- Your plan changes or terminates its contract with Medicare.
- There’s an opportunity for you to get other coverage.
Which Medicare Advantage Plan is best?
It depends on your specific situation and needs. If you need guidance about which Medicare Advantage plan works best for you, please call us at (888) 928-1456 TTY: 711 to speak with a licensed sales agent by phone or in person. We understand the challenges involved with choosing the right plan and are happy to help guide you through the process so you’re confident in your choice!
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Medicare Supplement coverage
Medicare doesn’t cover everything so Medicare Supplement insurance is additional insurance you can purchase through private insurers to supplement your Original Medicare (known as Parts A & B) plan to help pay out-of-pocket costs like deductibles, coinsurance and copayments. Your myHealthPolicy licensed insurance agent can work with you to help you find supplement coverage that’s right for you.
Learn MoreMedicare Part D coverage
Medicare Part D, also known as the Medicare Prescription Drug Benefit, is voluntary prescription drug coverage that you may purchase separately. Many Medicare Advantage plans already include Part D coverage. But if you’re covered by Original Medicare, or if your Medicare Advantage plan does not include Part D coverage, you can seek out a Part D standalone plan for prescription drug coverage. Explore further or contact a myHealthPolicy licensed insurance agent to help you with an option that’s right for you.
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