Does a Medicare Advantage Plan Replace Medicare?

Medicare Advantage (also known as Medicare Part C) provides an alternative way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage plan, you still have Medicare but you get your coverage through the Medicare Advantage plan rather than directly from Original Medicare. So does joining a Medicare Advantage plan mean you are replacing your Medicare coverage?

What is Medicare Advantage?

Medicare Advantage plans are a type of Medicare health plan offered by private companies under contract with Medicare. They provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage.

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. However, plans can charge different copayments, coinsurance, and deductibles for these services.

In many cases, Medicare Advantage plans also offer Part D prescription drug coverage. Some plans provide additional benefits Original Medicare doesn’t cover like dental, vision, and hearing services.

Each Medicare Advantage plan can have different provider networks, prescription drug formularies, and costs for services.

Does Medicare Advantage Replace Medicare?

Joining a Medicare Advantage plan doesn’t mean you are replacing your Medicare coverage entirely. Here’s how it works:

• You must have both Medicare Part A and Part B to join a Medicare Advantage plan.

• Once enrolled, you still have Medicare but now get your Part A and Part B benefits through your Medicare Advantage plan.

• You aren’t replacing Medicare, just changing how you get your core Part A and Part B benefits.

• You can go back to getting coverage directly from Original Medicare by disenrolling from your plan.

So in essence, Medicare Advantage provides an alternate way to get your Original Medicare benefits – it doesn’t replace Medicare altogether.

Comparing Medicare vs. Medicare Advantage

While you still have Medicare if you join a Medicare Advantage plan, there are some key differences in how the coverage works compared to Original Medicare:

Medicare

• Get Part A and Part B benefits directly from Medicare
• Free to see any provider accepting Medicare
• Pay 20% coinsurance for most Part B services
• Can add Medicare drug plans (Part D)
• Can get supplemental coverage (like Medigap)

Medicare Advantage

• Get Part A and Part B benefits from private plan
• Generally limited to in-network providers
• Out-of-pocket costs vary by plan
• Most plans include Part D drug coverage
• Cannot use supplemental coverage

While you still have Medicare, you get your benefits and coverage through the Medicare Advantage plan instead of getting them directly from Medicare.

Do You Lose Medicare if You Join an Advantage Plan?

No, you don’t lose Medicare completely if you enroll in a Medicare Advantage plan. However, here are some important things to know:

• You must continue paying your Part B premium to remain enrolled in Medicare.

• In most cases, you can only use providers in your plan’s network, except for emergencies.

• You may need referrals to see specialists with Medicare Advantage plans.

• You can’t use a separate Medigap or Medicare drug plan.

So while you still have Medicare, how you get your benefits does change significantly if you join a Medicare Advantage plan. Make sure you understand the plan’s coverage details.

Can I Go Back to Original Medicare?

Yes, you can disenroll from your Medicare Advantage plan and switch back to getting your benefits directly from Original Medicare. Here’s how it works:

• You can leave a plan during the Medicare Advantage Open Enrollment Period from January 1 to March 31 each year.

• Your coverage will switch back to Original Medicare starting the first of the month after you disenroll.

• You’ll pay the Part B premium to Medicare instead of the plan.

• You can enroll in a stand-alone Medicare Prescription Drug Plan and Medigap policy.

So you always have the option to go back to Original Medicare if a Medicare Advantage plan isn’t working for you. Just make sure you don’t go without Part D prescription drug coverage to avoid a late enrollment penalty.

Key Takeaways

Joining a Medicare Advantage plan doesn’t replace your Medicare completely. However, there are some important changes:

• You still have Medicare but now get Part A/B benefits through the Medicare Advantage plan.

• You can only use in-network providers, except for emergencies.

• You may pay different out-of-pocket costs compared to Original Medicare.

• You can disenroll and switch back to getting coverage directly from Medicare.

Overall, Medicare Advantage does not replace Medicare entirely but it does change how you get your Medicare benefits. Weigh the pros and cons carefully when deciding between Medicare Advantage and Original Medicare.