WHAT IS MEDICARE ADVANTAGE

Medicare Advantage expands health care options for Medicare beneficiaries. These options were created with the Balanced Budget Act of 1997 to reduce the growth in Medicare spending, make the Medicare trust fund last longer, and give beneficiaries more choices. 

With Medicare Advantage (also called Medicare Part C), you can choose from new ways in which to receive your Medicare benefits. 

It is important to remember that each of these options will have advantages and limitations, and no option will be right for everyone.  Also, not all options will be available in all areas. 

Please Note: If you do not actively choose and enroll in a new plan, you will stay in Original Medicare or the original Medicare managed care plan you currently have.  

When learning about these new options, please keep in mind that you do not have to change if you are happy with how you currently receive Medicare benefits.  You should not change to a new program until you have carefully analyzed it and determined how you would benefit from it.

Medicare Advantage Plans: Common Elements
  • All plans have a contract with the Centers for Medicare and Medicaid Services (Medicare).
  • The plan must enroll anyone in the service area that has Part A and Part B, except for end-stage renal disease patients.
  • Each plan must offer an annual enrollment period.
  • You must pay your Medicare Part B premium.
  • You pay any plan premium, deductibles, or copayments.
  • All plans may provide additional benefits or services not covered by Medicare.
  • There is usually less paperwork for you.
  • The Centers for Medicare and Medicaid Services (Medicare) pays the plan a set amount for each month that a beneficiary is enrolled.
The Centers for Medicare and Medicaid Services monitors appeals and marketing plans.  All plans, except for Private Fee-for-Service, must have a quality assurance program.

Who is eligible to enroll in a Medicare Advantage plan?

If you meet the following requirements, the Medicare Advantage plan must enroll you. You may be under 65 and you cannot be denied coverage due to pre-existing conditions.
  • You have Medicare Part A and Part B.
  • You pay the Medicare Part B premium.
  • You live in a county serviced by the plan.
  • You pay the plan's monthly premium.
  • You are not receiving Medicare due to end-stage kidney disease.

Another type of Medicare Managed Health Maintenance Organization is a Cost Contract HMO.  These plans have different requirements for enrollment.
  • You have Medicare Part A and Part B, or only Part B.
  • You pay the Medicare Part B premium.
  • You live in a county serviced by the plan.
  • You pay the plan's monthly premium.
  • You are not receiving Medicare due to end-stage kidney disease, and you are not in the Medicare Hospice program.

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