Some doctor’s offices call Medicare Advantage plans “replacement plans,” but they are more accurately called Part C of Medicare. These plans were created under the Balanced Budget Act of 1997 and signed into law by President Bill Clinton.
Medicare Advantage plans fall under Part C of Medicare. These plans often have networks, and some may require referrals to see specialists.
Congress designed this program to give Medicare beneficiaries a lower-premium option than Medigap. They also have very little Medicare underwriting. This means they are a coverage option for people who missed their open enrollment window for Medigap and now cannot qualify for Medigap due to health conditions.
How Medicare Advantage Works
A Medicare Advantage plan is a private health insurance plan that you can join as an alternative way to get your Part A and Part B benefits from Medicare. When you join a Medicare Advantage plan, Medicare will pay the plan a fee every month to administer your Part A and B benefits.
You must continue to be enrolled in both Medicare Part A and B while enrolled in your Medicare Advantage plan. Medicare pays the Advantage plan company on your behalf to take on your medical risk. This is how Medicare Advantage plans are funded.
You will present your Advantage plan ID card at the time of treatment and your providers will bill the plan instead of Original Medicare.
Each Advantage plan has its own summary of benefits that will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, labwork and so on.
Some of the higher copays may come in for diagnostic imaging, hospital stay, and surgeries. You can usually expect to spend several hundred on copays for these items. However, this varies greatly between states, so review plans in your area to get the specifics.
One neat thing about Medicare Advantage plans is that some of them offer minor benefits for routine dental, vision or hearing. Some plans include gym memberships. When searching for Medicare Advantage plans with dental and vision, our experts here at Boomer Benefits can help you compare those ancillary benefits between carriers.
See our Medicare Part C page for more on what Medicare Advantage covers.