What Is Medicare Advantage and How Does It Work?

What’s the difference between Medicare and Medicare Advantage?

With Original Medicare, you can see any doctor or facility that accepts Medicare. In comparison, Medicare Advantage plans have fixed networks of doctors and hospitals and must follow the rules set by Medicare. Also called ‘Part C,’ these bundled plans include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). They also usually have Part D coverage (for prescription medicine), so they’re sometimes referred to as an ‘all in one’ alternative to Medicare.

Additional benefits of Medicare Advantage can include:

• Copayments for doctor visits

• Vision and dental coverage

• Fitness programs

• Discounts for OTC drugs

• A range of other benefits depending on your requirements

Who can join a Medicare Advantage Plan?

There are some eligibility requirements that you need to meet when enrolling in a Medicare Advantage Plan:

• You need to be enrolled in Medicare Part A and Part B.

• You live in the service area of the plan you’re looking to join.

• You need to meet D-SNP criteria if applicable.

The most common types of Medicare Advantage Plans in NC

Almost 800,000 people in North Carolina are currently enrolled in a Medicare Advantage Plan. Some of the most common plans include:

• Health Maintenance Organization (HMO) Plans: these plans typically require a referral to see any type of specialist. You’re also generally required to stay in the network of listed providers except for emergency care or out-of-area urgent care. 

• Preferred Provider Organization (PPO) Plans: if you use health care providers that belong to the plan’s network, you’ll pay less for your care. You don’t typically require a referral on this plan.

• Dual Special Needs Plans (D-SNPs): you need to be enrolled in both Medicare and Medicaid to access this type of plan.

What to consider before joining a Medicare Advantage Plan

It’s important to check several things when taking out a Medicare Advantage plan, to make sure coverage meets your needs and budget. Our Medicare agents Charlotte recommend the following:

• Check the monthly premiums you will need to pay.

• Look at the copayments to make sure they fit your needs.

• Understand how coinsurance works, which refers to sharing the cost of services between you and Medicare.

• Discover the provider network to find out if your preferred doctors and health care providers are available with your plan. 

• Learn about whether prescription coverage is included and familiarize yourself with the formulary of drugs available to you.

• Understand your out-of-pocket limits so you can budget accordingly.

Need more information?

If you’re considering NC Medicare Advantage plans and need some help, our Medicare Advantage agents Charlotte are here to help. In addition, we have licensed agents throughout North Carolina. As a result, we can help you determine if a Medicare Advantage Plan is right for you. 

If you’ve got questions about what plan is right for you, for example, Medicare Advantage plans with dental and vision, contact us today. We can help you discover your options, including Blue Cross NC Medicare Advantage, which provides flexibility for your needs.