If you’re quickly approaching the deadline to sign up for Medicare, you might be feeling a little overwhelmed. You know you need to sign up for Original Medicare within the seven months surrounding your 65th birthday, but also know that having only Original Medicare may not cover everything you need.
There are two common paths for ensuring additional coverage once you’re signed up for Medicare: Medicare Advantage and Medicare supplement. In this article, we’re answering the top questions about Medicare Advantage, busting some myths, and hopefully making it easier for you to decide if it’s right for you.
Medicare Advantage basics
No matter the kind of extra coverage you choose, you need to first enroll in Original Medicare (Parts A and B), which is managed by the federal government. When you sign up for Medicare Advantage (also known as Part C), a private health insurance company manages your Part A and B benefits, and sometimes prescription drug benefits (Part D) all together under one plan.
Coverage provided by a Medicare Advantage plan is required to be as good as or better than benefits under Original Medicare. There are other benefits to enrolling in Medicare Advantage, which may include:
- Low or no monthly premiums
- Premiums stay the same regardless of age or health status
- Lower copays or deductibles compared to Original Medicare
- An out-of-pocket maximum for more predictable spending
- Additional benefits like routine vision, hearing, dental and healthy living benefits — at no additional cost
What does Medicare Advantage cover? Medicare Advantage plans provide hospital coverage, medical coverage, prescription drug coverage, dental care, vision care, hearing care, and gym memberships. Some plans may not cover all the items listed, and some plans may provide even more coverage. You'll need to look at the specific plan you're interested in for more details.
Answering your top questions about Medicare Advantage
Now that you know the basics, let’s get into the most commonly asked questions about Medicare Advantage plans.
Can I keep seeing my doctor with Medicare Advantage?
Most Medicare Advantage plans use a network of doctors and hospitals. The federal government ensures everyone with Medicare Advantage has access to in-network providers, and requires plans to help members find a provider and cover their services at the in-network rate if there isn’t an in-network specialist for your condition. When you’re choosing your plan, review the plan's provider directory to make sure your current doctor(s) is in-network.
Am I covered by my Medicare Advantage plan when I travel?
Some Medicare Advantage plans include a travel benefit. Whether you’re traveling for a few weeks or spending several months someplace warm, a Medicare Advantage travel benefit will give you peace of mind. This means your Medicare coverage travels with you wherever you go, and you’re always covered at in-network rates if you have an emergency.
How are Medicare Advantage plans able to offer low or $0 premiums?
Medicare Advantage plans receive star ratings from the federal government (with one star being the lowest and five stars being the highest) to ensure they meet certain quality standards and take care of their members. The majority of Medicare Advantage plans External Site (81 percent in 2021) have a star rating of 4 or higher, which means they receive additional quality bonus payments from Medicare. These payments can be used to lower the cost of premiums or provide additional benefits beyond what Original Medicare offers, though it's not a requirement for plans to do so.
Are there any downsides to Medicare Advantage?
Low or no monthly premiums, extra health and fitness benefits, and coverage while you’re traveling make Medicare Advantage sound like a great choice. While many Medicare Advantage plans offer a lower monthly premium, they typically come with higher out-of-pocket costs for services you'll need to plan for. Plus, because most plans typically have a network of providers you must see to keep costs as low as possible, you will also need to make sure your doctor is in your plan's network, or find a new one. If you need more help deciding on a plan that's best for your lifestyle and budget, you can speak to an authorized Wellmark agent Opens New Window to discuss your options at no cost to you.
Can I expect the same benefits and coverage from all Medicare Advantage plans?
Unlike Medicare supplement plans, which provide standardized coverage across all health insurance carriers, Medicare Advantage plans will differ based on the private health insurance company you choose. Typically, those differences include varied provider networks, premium costs, prescription drug coverage, and extra benefits.
If I pay a premium for Medicare Advantage, do I still have to pay my Part B premium?
In order to be enrolled in a Medicare Advantage plan, you need to first be enrolled in Original Medicare. This means you will still need to pay the monthly Part B premium in addition to your Medicare Advantage premium (although there are $0 premium options available).
Aren't Medicare Advantage and Medicare supplement the same thing?
Medicare supplement, sometimes known as Medigap, fills in coverage gaps in Original Medicare and does not provide all-in-one coverage like Medicare Advantage, which includes drug coverage and extras like dental, vision, hearing, and fitness benefits. With a Medicare supplement plan, you need to purchase prescription drug, vision, hearing and dental coverage separately, depending on what you need. You can’t have both Medicare Advantage and a Medicare supplement plan, so you’ll need to choose the option that’s right for you.
Have more questions about Medicare Advantage?
We’re here to help. If you live in Iowa or South Dakota, you can request your free Medicare Get-Ready Guide Opens New Window to learn more about the different parts of Medicare, your coverage options, and when you're eligible to enroll. You can also call us directly at 800-336-0505.
If you live outside Iowa or South Dakota, visit the Blue Cross Blue Shield Association website External Site or call 888-630-2583 to find a Blue plan near you.