A Deeper Dive into Medicare Advantage Plans (MA)

Medicare Advantage Plans, offered by private insurers like UnitedHealthcare, are approved and contracted by the federal government, following CMS rules. Medicare pays these companies a fixed amount monthly for care. Here’s what you need to know:

 

Coverage:

    • MA Plans must provide the same coverage as Original Medicare.
    • Many offer additional benefits, including Part D prescription drug coverage.
    • These are not Medicare Supplement Insurance Plans, so cost-sharing cannot be covered by a Supplement Plan.
    • Hospice care is still administered under Medicare Part A.

Eligibility and Enrollment:

    • Must be entitled to Part A, enrolled in Part B, and live in the plan’s service area.
    • No denial for pre-existing conditions, but Special Needs Plans have specific criteria.
    • A valid election period is needed for enrollment or disenrollment.

Costs:

    • Plan structure and costs vary widely.
    • Cost-sharing is often in the form of copayments, providing predictability.
    • Each plan has an annual out-of-pocket (OOP) maximum for Medicare-covered benefits, not exceeding the CMS limit.
    • Monthly plan premiums may be charged in addition to the Part B premium.

Out-of-Pocket (OOP) Maximum:

    • Limits the total amount spent on Medicare-covered Part A and B benefits annually.
    • Once the OOP maximum is met, no cost-sharing for covered benefits for the rest of the year.
    • OOP maximums vary by plan but must comply with CMS limits.
    • Costs for non-Medicare-covered benefits and plan premiums don’t count toward the OOP maximum.

Considering an MA Plan? Make sure to review the specific details and benefits of each plan to find the best fit for your needs! 💡✨