Understanding Medicare Advantage Plans

Understanding Medicare Advantage Plans

Understanding Medicare Advantage Plans

Your Medicare Advantage Plan can help you get the coverage and treatment you need for a number of different conditions and treatment types. But what can you expect from this plan, and which physicians and providers accept Medicare Advantage in North County? Learn more in our guide or reach out to the GTCIPA team for further information and support.

What Is Medicare Advantage?

Medicare Advantage Plans are similar to your standard Medicare plan, helping you to connect with the care you need without the hassle or the financial worry. Often called Medicare Part C Plans, or MA Plans, this type of Medicare effectively bundles together the care you receive from Part A and Part B of your coverage, adding other types of coverage in some cases.

The Medicare Advantage network is an extension of the Medicare network. Providers who handle MA Plans are private sector organizations who have been approved to join the Medicare Advantage network. They may also be able to offer the drugs and medications you need under the plan — provided as Part D coverage.

In most cases, the MA Plan will cover all required, urgent, or emergency treatment and care. This treatment and care will be administered by the approved providers within the program network, who will accept Medicare Advantage in North County or in any other location you are a resident in. Double-check that your plan covers any non-emergency  — this type of care may be provided by companies outside of the network, and you may have to cover more of the cost with your personal finances.

How Do Medicare Advantage Plans Work?

Medicare Advantage Plans work in much the same way as standard Medicare plans, although they extend the coverage in most cases. In other words, you will still receive Part A and Part B coverage of your original Medicare plan, but this will be bundled together as Part C — i.e., the Medicare Advantage Plan.

MA Plan Coverage

Some Medicare Advantage Plans cover an extended array of treatments and associated costs. Check the terms of your specific plan to find out if the following are covered:

  • Eye health treatments, vision treatments, and eye testing
  • Hearing tests and auditory health treatments
  • Oral and dental treatments
  • External fitness services such as gym memberships
  • Any drugs and medication that are required — Part D coverage

Covering the Payment of Treatment

Treatments and care will still need to be paid for. Generally, this will be paid for by the original Medicare program. This program will provide payments to the approved providers within the Medicare Advantage network, and it is these providers who will deliver the treatment. This Medicare payment is a fixed amount of money that is delivered to the provider each month.

You will often have to pay some money out of your own pocket to cover treatment, but the bulk of the cost will be borne by Medicare. The costs you must bear will vary according to:

  • The type of Medicare Advantage Plan
  • Any referrals you receive for specialist treatment
  • Any care or treatment deemed to be non-urgent — generally delivered by a Medicare Advantage Partner or a member of the network

Medicare Supplement Insurance (Medigap)

Unfortunately, you cannot use or enroll in a program of Medicare Supplement Insurance while you are using a Medicare Advantage Plan. You also will not be able to claim upon an existing Medigap insurance policy while your Medicare Advantage Plan is active.

Medicare Advantage Physicians at GTCIPA

To find physicians accepting Medicare Advantage in North County, reach out to the GTCIPA team. Get in touch to book your appointment with Medicare physicians at GTCIPA, and get started today.