Learn about Medicare Advantage
Medicare Advantage, also known as Part C, offers additional medical benefits not covered by Original Medicare. These plans may include benefits like dental, vision and hearing, as well as Part D prescription drug benefits. Medicare Advantage plans are available through private insurance companies like Blue Cross Blue Shield of Michigan.
How do I enroll in Medicare Advantage?
You can enroll in a Medicare Advantage plan during your initial enrollment period or special enrollment period, but only after you have signed up for both Parts A and B.
Medicare Advantage members can change plans each year during the annual enrollment period from Oct. 15 to Dec. 7.
You can enroll in a Medicare Advantage plan directly with a private insurance company, usually over the phone, in person or by going online. An agent or broker can also help you sign up for a plan.
There's no penalty for enrolling late in a Medicare Advantage plan. If you didn't sign up for a Medicare Advantage plan during your initial enrollment period, you can do so during the annual enrollment period from Oct. 15 to Dec. 7.
Keep in mind that for Original Medicare and Part D prescription drug plans, there may be penalties for late enrollment. Most penalties won't apply if you or your spouse are still working and are covered by an employer health plan.
Choosing your coverage
There are different levels of Medicare Advantage coverage that vary in price and benefits. Each has its own range of plan options for you to choose from, and some include unique offerings like fitness memberships and over-the-counter benefits. You should compare plan benefits, costs and networks to determine the right plan for you.
What's included with Medicare Advantage
Here's a high-level overview of the coverage that's included in most Medicare Advantage plans.
- Hospital care
- Medical care
What may be included
Coverage while traveling domestically, long-term nursing care, routine dental, routine vision, hearing aids and prescription coverage.
You can choose from any private Medicare insurance companies in your state that offer coverage in your area. Each private insurance company offers a variety of plans to match different needs.
Preventive services help you identify and treat health problems early so you can stay healthy.
These include exams, shots, lab tests and screenings, among others. Medicare Part B covers some preventive care services, although you may have a 20% coinsurance on services after you have met your deductible. If you have a Medicare Advantage plan, your private insurance provider will have a list of preventive services they cover.
If you choose a Medicare plan from Blue Cross Blue Shield of Michigan, which has the largest network of providers in the state, there's a good chance your doctor will be covered.
With a Medicare supplement plan, you can see any doctor who accepts Medicare. If your doctor doesn't accept Medicare, they can choose to accept you as a patient, but you’ll be responsible for payment.
With a Medicare Advantage plan, your doctor must participate in the plan's network. You can check whether your doctor is in our network with Find a Doctor.
What type of Medicare Advantage plan should I get?
When you sign up for a Medicare Advantage plan, you can choose from three different plan types through Blue Cross Blue Shield of Michigan:
- Health maintenance organization, or HMO
- Health maintenance organization point of service, or HMO-POS
- Preferred provider organization, or PPO
Your options will vary depending on your eligibility and what private insurance companies offer in your area.
When choosing your network type, you should consider if your preferred doctors and hospitals are in that network, your travel habits and costs.
How these networks compare
HMO and HMO-POS
With an HMO or HMO-POS plan, you must get your care and services from providers in your plan’s network. You may have lower costs, such as your monthly premium, with an HMO plan.
-
Lower premiums
-
A primary care physician who coordinates your care
PPO
With a PPO plan, you have a wider network of doctors and hospitals to choose from. However, you will pay less if you choose to get in-network care.
-
A wider network of doctors and hospitals
-
The freedom to choose your own specialists
How much will my Medicare Advantage plan cost?
Your costs will vary based on the provider and the coverage included in your chosen plan.
You’ll want to compare plans to understand how much premiums are in relation to out-of-pocket costs like copays and coinsurance. While some Medicare Advantage plans may have lower premiums, they may have higher out-of-pocket expenses.
These terms all describe money you pay toward health care when you have a health insurance plan.
Copay and coinsurance
A copay is a fixed amount of money you pay for a certain service. Your health insurance plan pays the rest of the cost.
Coinsurance refers to percentages.
Our Medicare Advantage plans use copays for most services. You pay 20% coinsurance for most services with Original Medicare.
Deductible
A deductible is the amount of money you pay for care before your plan starts paying. For most services, you'll pay the full cost until you reach the deductible. After you reach your deductible, you’ll still have to pay any copays or coinsurance.
Most Medicare Advantage plans have separate medical and pharmacy deductibles. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. We pay the Original Medicare deductibles for you.
How they all work together
When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. When you reach a certain amount, we pay for most covered services. This is called the out-of-pocket maximum.
Original Medicare doesn’t have an out-of-pocket maximum. There's no cap on what you pay out of pocket. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. After that point, you pay the full amount each day.
Important information about Medicare supplement plans
This is a solicitation of insurance. We may contact you about buying insurance. Blue Cross Medicare Supplement plans aren't connected with or endorsed by the U.S. government or the federal Medicare program.