Since 1966, the government’s Medicare program, also known as Medicare Part A and Part B, has helped millions of Americans obtain health care. It includes basic hospital coverage (known as Medicare Part A) and basic medical coverage (known as Medicare Part B).
Unfortunately, Medicare Part A and Part B can become expensive. For more trips to the doctor, you must pay for 20% of your care out-of-pocket. And, there is no maximum cap on these fees, meaning the more care you need, the more you may have to pay. Medicare Part A and Part B also do not cover prescription drugs, meaning you do not get any help paying for medication at the pharmacy or by mail. Add to that the fact that there is usually no coverage for dental, vision, or long term care, and Medicare Part A and Part B can have gaps in coverage that may not be enough for your needs.
Fortunately, the government has authorized certain health insurance companies to offer Private Medicare plans (also known as Medicare Part C) that provide the same coverage as Parts A and B and often include additional benefits. It is important to note that Medicare Part C replaces Medicare Part A and Part B, and cannot be used in conjunction with Part A and Part B plans. However, Private Medicare plans may be a great way to help lower your out-of-pocket costs and get additional benefits.
MedicareAdvantageUSA.com has access to many Medicare health insurance companies offering Private Medicare plan options with one simple to use website. Helping you make sense of your enrollment options has never been easier with MedicareAdvantageUSA.com.
Learn more about https://www.medicareadvantageusa.com/ and some common Medicare questions here.
To start comparing your options, just enter your zip code to begin. You can also call (855) 950-4434 TTY users 711 to speak to a licensed insurance agent. Mon - Fri: 5am - 7pm, Sat - Sun: 5am - 8pm PT
What are Medicare Advantage Plans?
Medicare Advantage Plans — also known as Part C Plans – are offered through private insurance carriers, and can be a great way to get additional health coverage. Depending on your medical needs, these plans can help you significantly lower your out-of-pocket health care costs.
By law, all Medicare Advantage Plans include your Original Medicare benefits. What this means is you get your Parts A & B benefits, and may receive additional benefits, all in one convenient plan. Some Medicare Advantage plans include prescription drug coverage, dental, vision, wellness programs, and more.
Do I Need a Medicare Advantage Plan?
Only you can decide how much medical coverage you need. That said, and generally speaking, those who only have Original Medicare risk unaffordable out-of- pocket costs — especially when faced with an extended hospitalization or if they require frequent outpatient medical care.
For instance, as of 2021, unless beneficiaries have drug coverage from another source that is at least as good as standard Part D coverage (“creditable coverage”), they face a penalty equal to 1% of the national average premium for each month they delay enrollment.
Out-of-pocket costs can add up when visiting the doctor or for outpatient care too. Though Original Medicare Part B pays 80% of outpatient costs, you must pay for the remaining 20% on your own. Again, since there is no maximum out-of-pocket limit, that 20% can really add up, especially for those with chronic or major illnesses. Fortunately, Medicare Advantage Plans protect you financially by capping your out-of-pocket costs with a maximum limit each year.
How Much Does it Cost?
Some plans with $0 premiums may even include prescription drug coverage — known as Medicare Advantage Prescription Drug Plans. Deductibles, or the amount you must pay before the plan’s coinsurance kicks-in, also start around $0 per year. The maximum out-of-pocket limit starts around a couple of thousand dollars per calendar year. However, premiums, deductibles, and maximum out-of-pocket limits do vary by plan to plan, and depending on where you live.
Who is Eligible?
You are eligible for a Medicare Advantage Plan if (1) you currently have Original Medicare, and (2) if a plan is available in your area.
To be eligible for Original Medicare, generally speaking, you must be 65 years or older and have paid federal taxes for at least 10 working years. Those under 65 years old are eligible for Original Medicare if they have a qualifying disability.
What Is It?
Medicare Part A and Part B does not include coverage for prescription drugs at the pharmacy or in the mail. Fortunately, the government has allowed certain private insurers to offer Medicare Prescription Drug plans (also known as Medicare Part D).
There are two types of Part D plans. The first type is Medicare Advantage Prescription Drug Plans (MAPDPs). This type of coverage is included as part of a Medicare Advantage plan, so you will only be able to access this plan’s coverage if you enroll in a Medicare Advantage plan (also known as Medicare Part C), that includes Prescription Drug (Part D) coverage.
The other type is standalone Prescription Drug Plans (SPDPs). This is the type of coverage you get separately along with Medicare Part A and Part B. So, you have two choices for drug coverage: Medicare Part A, Part B, and a standalone prescription drug plan (Medicare Part D), or Medicare Advantage with a Medicare Advantage Prescription Drug Plan. If you have Original Medicare and a Part D standalone prescription drug plan, you may also have a Medicare Supplement plan.
Why Get It?
Paying for prescription drugs out-of-pocket can be very expensive. If you are currently taking medication, or think you may need to, it is highly recommended to get a Medicare Prescription Drug Plan.
Who Is Eligible?
You must have Medicare Part A and/or Part B to get a Medicare Prescription Drug plan.
When Can I Enroll?
Both Medicare Advantage Prescription Drug Plans and Standalone Prescription Drug Plans are best purchased during the Initial Enrollment Period or the Annual Enrollment Period.
The Initial Enrollment Period is the 7-month period surrounding your 65th birthday -- 3 months before the month you turn 65, the month you turn 65, and 3 months after the month you turn 65.
After the Initial Enrollment Period, the next time Medicare beneficiaries can enroll in a prescription drug plan is the Annual Enrollment Period, which begins on October 15 and ends on December 7. You may also switch Prescription Drug plans during the Annual Enrollment period if you are already enrolled in one and would like to change plans.
It may be possible to enroll in a Prescription Drug plan during a Special Enrollment Period. It is important to remember that a Special Enrollment Period is only open to those who recently experienced certain major life changes, such as moving out of their plan’s service area or a loss of health coverage.
Since Special Enrollment is limited, it is important that you do not miss the Initial or Annual Enrollment Periods.
Finally, there are two additional opportunities to change plans if you are already enrolled.
If you are enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan, or switch to Original Medicare (and join a separate Medicare drug plan) one time from January 1 through March 31 each year. And if you have to pay a premium for Part A and/or enroll in Part B during the General Enrollment Period, you can also join a Prescription Drug Plan from April 1 through June 30.
How Much Does It Cost?
Monthly premiums for Medicare Prescription Drug Plans vary by carrier, plan, and the state you live in.
When shopping for a plan, it is important to compare plans side by side, and by formulary. The formulary is the exact drugs that the plan covers, and different formularies have different costs.
How to Enroll?
You can compare Medicare Prescription Drug options here on MedicareAdvantageUSA.com! You can apply once you find the right plan for your needs. To begin, just enter your zip code and tell us about yourself. You can also call (855) 950-4434 TTY users 711 Mon - Fri: 5am - 7pm, Sat - Sun: 5am - 8pm PT to speak with a licensed insurance agent.
Medicare Part A and Part B is the health insurance provided by the government. It consists of both Part A or hospital insurance, and Part B, or doctor visits and outpatient coverage.
There are three enrollment periods for Medicare Part A and Part B. First is the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday. It begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after you turn 65. Those who are under 65 and have a qualifying disability can also enroll in Medicare Part A and Part B.
Those who are over 65 are eligible if they paid federal taxes for at least 10 working years. If you already receive benefits from Social Security or the Railroad Retirement Board, you will automatically be enrolled in Medicare. If you do not yet receive these benefits, or have questions about your eligibility for Medicare Part A and Part B, check with the government or visit Medicare.gov.
The General Enrollment Period is available to those who missed the Initial Enrollment Period. It begins on January 1st and ends on March 31st.
The third opportunity to sign up for Medicare Part and Part B is during a Special Enrollment Period. Individuals eligible for premium-free Part A can enroll in Part A at any time after they are first eligible for the coverage. Individuals who want premium Part A, Part B or both may only enroll during certain enrollment periods that are outlined in law. The following enrollment periods apply to both premium Part A and Part B: Initial enrollment period, General enrollment period, and Special enrollment period for the working aged, the working disabled, and international volunteers.