Medicare 101: Know the basics

Posted by: Simone Manlove

As your source to learn everything on Medicare Advantage, Better Medicare Alliance wants to make sure beneficiaries know the facts. Medicare Academy week one is complete, and advocates got to learn about the basics from enrollment to types of MA plans. The most powerful tool an advocate can have to help BMA fight for affordable, high quality care is knowledge of the issues. Once you understand Medicare Advantage coverage, enrollment, benefits and limitations together we can build a stronger voice to advocate.  Consider this your cheat sheet to Medicare Advantage 101.

Key terms

Medicare Advantage: A Medicare coverage option that provides Part A and B benefits, as well as enhanced or supplemental benefits such as hearing, dental, vision, and wellness benefits.

Open enrollment: Annual time period when beneficiaries can join a Medicare Advantage plan, switch Medicare Advantage plans, or leave a Medicare Advantage plan and enroll in Traditional Fee-for-Service Medicare.

Enhanced benefits: Vision, hearing, dental, and wellness benefits that are offered by 97% of Medicare Advantage plans.

Dual eligible: A beneficiary who is eligible for both Medicare and Medicaid.

Extra Help: A program that helps beneficiaries with limited incomes and resources pay for Medicare prescription drug costs.

Open enrollment takes place from October 15 to December 7 each year. You can choose a Medicare Advantage plan during your initial enrollment period or each year during open enrollment. You could change Medicare plans each year depending on your economic and health needs but only during open enrollment period.

The total enrollment of Medicare Advantage beneficiaries exceeds 20 million. Individuals eligible for Medicare Advantage include people age 65 or older, people who are disable and people with pre-existing condition (except ESRD which has special rules under Medicare Advantage).

Medicare Advantage is another way to get Medicare coverage. When you choose Medicare Advantage your health coverage is provided through a Medicare Approved Organization rather than the federal government. Unlike Traditional Medicare, for which you pay a separate monthly premium for Part A (Hospital), Part B (Doctors, Outpatient), and Part D (Prescription Drugs), Medicare Advantage covers all Parts A, B, and if selected, Part D all in one monthly premium, often at a lower cost to you.

As an extra help, most Medicare Advantage plans also cover additional benefits, such as dental, hearing, vision and transportation at no additional cost. The biggest difference from traditional Medicare and Medicare Advantage is that Medicare Advantage has an annual out out-of-pocket spending limit.

Research has showed Medicare Advantage enrollees experience fewer hospitalizations than Traditional Fee-for-Service Medicare beneficiaries and often have access to chronic disease management. The type of Medicare Advantage plan you enroll in (i.e. PPO, HMO, SNP, PFFS) could impact the services or providers you receive.


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