Understanding Medicare Advantage Plans.

1 Understanding Medicare Advantage PlansCENTERS FOR Medicare & MEDICAID SERVICESThis official government booklet tells you: How Medicare Advantage Plans are different from Original Medicare How Medicare Advantage Plans work How you can join a Medicare Advantage Plan Understanding Medicare Advantage Plans isn t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit , or call 1-800- Medicare (1-800-633-4227) to get the most current information.

2 TTY users can call ..4 What are the differences between Original Medicare and Medicare Advantage ?..5 What are Medicare Advantage Plans?..9 How do Medicare Advantage Plans work?..9 What do Medicare Advantage Plans cover? ..9 What are my costs? .. 10 Who can join a Medicare Advantage Plan? .. 12 When can I join, switch, or drop a Medicare Advantage Plan? .. 13 How can I join a Medicare Advantage Plan?..14 Types of Medicare Advantage Plans..15 Compare Medicare Advantage Plans side-by-side..24 What if I have a Medicare supplement Insurance (Medigap) policy? ..25 Where can I get more information?

3 264W hen you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare are 2 main ways to get Medicare : Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D). Medicare Advantage (also known as Part C ) is an all in one alternative to Original Medicare . These bundled plans include Part A, Part B, and usually Part D. Most plans offer extra benefits Original Medicare doesn t cover like vision, hearing, dental, and Medicare health plan decisions affect how much you pay for coverage, what services you get, what doctors you can use, and your quality of about your Medicare coverage choices, getting help from people you trust, and comparing different plans can help you understand all the options available to you.

4 Introduction5 What are the differences between Original Medicare and Medicare Advantage ?Original Medicare Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D). To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage. You can use any doctor or hospital that takes Medicare , anywhere in the Part A Part B You can add: Part D You can also add: Supplemental coverage This includes Medicare supplement Insurance (Medigap).

5 Or, you can use coverage from a former employer or union, or Advantage (also known as Part C) Medicare Advantage is an all in one alternative to Original Medicare . These bundled plans include Part A, Part B, and usually Part D. Plans may have lower out-of- pocket costs than Original Medicare . In many cases, you ll need to use doctors who are in the plan s network. Most plans offer extra benefits that Original Medicare doesn t cover like vision, hearing, dental, and more. Part A Part B Most plans include: Part D Extra benefits Some plans also include: Lower out-of-pocket-costs6 Original Medicare vs.

6 Medicare AdvantageDoctor & hospital choiceOriginal MedicareMedicare AdvantageYou can go to any doctor or hospital that takes Medicare , anywhere in the many cases, you ll need to use doctors and other providers who are in the plan s network and service area for the lowest costs. Some plans won t cover services from providers outside the plan s network and service most cases you don t need a referral to see a may need to get a referral to see a MedicareMedicare AdvantageFor Part B-covered services, you usually pay 20% of the Medicare -approved amount after you meet your deductible.

7 This is called your coinsurance. Out-of-pocket costs vary plans may have lower out-of-pocket costs for certain services. You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan (Part D), you ll pay that premium may pay the plan s premium in addition to the monthly Part B premium. (Most plans include drug coverage (Part D).) Plans may have a $0 premium or may help pay all or part of your Part B s no yearly limit on what you pay out of pocket, unless you have supplemental coverage like Medicare supplement Insurance (Medigap).Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers.

8 Once you reach your plan s limit, you ll pay nothing for services Part A and Part B covers for the rest of the can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or can t buy and don t need Medigap. 7 Original Medicare vs. Medicare Advantage (continued)CoverageOriginal MedicareMedicare AdvantageOriginal Medicare covers most medically necessary services and supplies in hospitals, doctors offices, and other health care settings. Original Medicare doesn t cover some benefits like eye exams, most dental care, and routine must cover all of the medically necessary services that Original Medicare covers.

9 Most plans offer extra benefits that Original Medicare doesn t cover--like some vision, hearing, dental, routine exams, and more. Plans can now cover more of these can join a separate Medicare drug plan (Part D) to get drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you don t need to join a separate Medicare drug most cases, you don t have to get a service or supply approved ahead of time for Original Medicare to cover some cases, you have to get a service or supply approved ahead of time for the plan to cover MedicareMedicare AdvantageOriginal Medicare generally doesn t cover care outside the You may be able to buy a Medicare supplement Insurance (Medigap) policy that covers care outside the generally don t cover care outside the 89 What are Medicare Advantage Plans?

10 A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called Part C are offered by Medicare -approved private companies that must follow rules set by Medicare . Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans (see page 15). Each of these Medicare Advantage Plan types have special rules about how you get your Medicare covered Part A and B services and your plan s supplemental you join a Medicare Advantage Plan, you ll still have Medicare but you ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare .