Medicare Advantage facts for kids
Medicare Advantage (also known as Medicare Part C or MA) is a type of health plan. Private companies offer these plans, but they must follow rules set by Medicare. Medicare is a government program that helps older adults and some people with disabilities pay for healthcare. Most Medicare Advantage plans also include coverage for prescription drugs (Part D).
With Medicare Advantage, Medicare pays a set amount of money to the private company. This company then pays for the healthcare costs of the people in their plan. These plans must offer at least the same benefits as regular Medicare (Parts A and B). However, they can offer extra benefits too, like vision or dental care.
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How Medicare Advantage Works
Medicare Advantage plans must cover the same basic services as Original Medicare. This includes hospital care (Part A) and doctor visits (Part B). Many plans also include prescription drug coverage (Part D). Some plans offer even more benefits, like help with hearing, dental, or vision care. These extra benefits might mean you pay a bit more each month.
One big difference is that Medicare Advantage plans often have a yearly limit on how much money you have to pay for your healthcare. This is called an "out-of-pocket maximum." Once you reach this limit, the plan pays 100% of your covered costs for the rest of the year. Original Medicare (Parts A and B) does not have this kind of yearly limit.
Most Medicare Advantage plans are like private health insurance plans. They often use a network of doctors and hospitals. This means you might need to see doctors or go to hospitals that are part of your plan's network.
Medicare and Medicaid Together
Some Medicare Advantage plans are special because they cover both Medicare and Medicaid services. These plans are for people who qualify for both programs. To get both, a person usually needs to be 65 or older (or have certain disabilities) for Medicare. For Medicaid, they need to have a low income and few assets. Medicaid rules can be different in each state.
Special Benefits for Health Needs
Some Medicare Advantage plans try new ways to help people with specific health needs. For example, they might offer special benefits to help people manage certain diseases better. This could include help with getting healthy food or connecting with others to avoid feeling lonely. These special benefits are part of a program called "Value-Based Insurance Design."
Who Uses Medicare Advantage
More and more people are choosing Medicare Advantage plans. In 2021, about 26.5 million people were enrolled in these plans. This number has grown a lot since 1998. Today, about half of all people with Medicare are in a Medicare Advantage plan. Most people with Medicare can find many different Medicare Advantage plans in their area.
Concerns About Medicare Advantage
Sometimes, there are concerns about how Medicare Advantage plans work. In 2019, some plans denied requests for care that would have been approved by Original Medicare. There have also been concerns that some private companies might report that their members are sicker than they actually are. This can lead to the government paying the plans more money than they should.
Because of these concerns, there have been investigations into how some companies manage their Medicare Advantage plans. Critics say that these practices can cost taxpayers more money. Also, while Original Medicare lets people see any doctor who accepts Medicare, many Medicare Advantage plans limit which doctors and hospitals you can visit.
