How Medicare Advantage Works
When someone enrolls in a Medicare Advantage plan, Medicare pays the private insurance company a set amount each month to manage the person's care. The member still has Medicare, but receives benefits through the plan instead of using Original Medicare as the primary coverage arrangement.
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What Medicare Advantage Plans May Include
- ✓ Hospital and medical coverage through Part A and Part B benefits.
- ✓ Usually prescription drug coverage through Part D.
- ✓ Potential extra benefits such as vision, hearing, dental, fitness, transportation, or meal-related benefits, depending on the plan.
Important Shopping Factors
- ✓ Provider network rules such as HMO or PPO structure.
- ✓ Whether referrals are required to see specialists.
- ✓ Drug formulary and pharmacy network.
- ✓ Maximum out-of-pocket limit for covered Part A and Part B services.
- ✓ Monthly premium in addition to the Part B premium, if any.