Laying a Solid Foundation | Lesson 2

Medicare Advantage Basics

What is a Medicare Advantage plan?

Also known as Medicare Part C, Medicare Advantage (MA) is privately offered health insurance coverage.

These plans are federally regulated by the Centers for Medicare & Medicaid Services (CMS).

At their base, Medicare Advantage products must cover all services covered by original Medicare.

However, many of these plans offer additional benefits not covered in Original Medicare like prescription drugs, dental benefits, and fitness memberships.

Most MA plans work with a select group of doctors, hospitals, and other providers called a network.

By doing so, these plans can negotiate what they’ll pay to those in-network providers for medical services.

Because of these agreements, MA beneficiaries tend to have lower out-of-pocket costs.

Similar to stand-alone prescription drug plans, if a Medicare Advantage plan includes drug coverage, it will have a formulary which lists covered prescriptions often using a tiered cost structure.

Now that we know a bit more about them, who can join a Medicare Advantage plan?

To join a Medicare Advantage plan, your client must qualify and be enrolled in both Part A and Part B of Original Medicare, and live in the plan’s service area.

That should cover the basics.

Check out the next lesson to learn more about the different types of Medicare Advantage plans.

Watch the Next Lesson