What Is Medicare Advantage?
Medicare Advantage is a health insurance option that provides a combination of coverage, including some things that Original Medicare provides. It may also include things that Original Medicare doesn’t cover, like prescription drugs, vision, hearing, dental, and wellness programs. There are a variety of private companies that have been approved by Medicare to offer Medicare Advantage plans, which must follow certain guidelines established by Medicare. Regardless, the plans available could have slightly different coverage options and costs associated with them but could fall under a:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO) Plan
- Dual Special Needs Plan (D-SNP), or
- Chronic Special Needs Plan (C-SNP).
The program should outline what doctors are within the plan’s network and the costs associated with using a doctor that’s not in the network. In addition, different plans may have different out-of-pocket costs and requirements like referrals to see a specialist. Again, each plan is different—so knowing about the options available is essential.
How Someone May Qualify
Eligibility for Medicare Advantage depends on the plan; however, there are general factors that should qualify someone for a Medicare Advantage plan. Such factors may include living in the service area of the plan and if the person currently has Medicare Parts A and B. Those that have Original Medicare may have qualified for these plans due to their age, disability, or having End-Stage Renal Disease (ESRD).
How to Apply for a Medicare Advantage Plan
The process of applying for a Medicare Advantage plan can vary depending on the plan you’re applying for. Individuals should take the appropriate steps to determine what plan is best for them and how to apply for that plan. The application process could involve going to the plan’s website, filling out a paper form, or giving them a call.