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Question - Assistance - Enrollment
Our Q&A page is here to give you quick, clear answers to your questions, making it easy to find the info you need. We simplify the details so you can get the answers fast and stay engaged!
Categories
Understand what Medicare Advantage is and how it compares to Original Medicare.
​2. Costs & Premiums
Learn what you may pay — including premiums, copays, and out-of-pocket limits.
3. Prescription Drug Coverage (Part D)
Find out how drug coverage works within Medicare Advantage plans.
See which plans may include vision, dental, hearing, fitness, and more.
Know how to check if your doctor or hospital is in-network — and what that means.
6. Plan Types (HMO, PPO, etc.)
Explore the differences between HMO, PPO, PFFS, and other Medicare Advantage options.
7. Enrollment & Switching Plans
Understand when and how you can join, switch, or leave a plan.
Learn how your coverage works if you're traveling or relocating.
Discover plan options designed for people with specific health or financial needs.
Get clear on what’s covered, what's not, and how Medicare Advantage rules work.
​11. Other Questions
The catch all information
1. Medicare Advantage Basics
What is Medicare Advantage and how is it different from Original Medicare?
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Medicare Advantage (Part C) provides an alternative to Original Medicare (Part A & Part B) by bundling coverage, often with additional benefits like vision, dental, and hearing. Original Medicare only covers hospital (Part A) and medical services (Part B), without these extra benefits.
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Will I lose my Medicare if I enroll in a Medicare Advantage plan?
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No, you do not lose your Original Medicare benefits. Medicare Advantage is an alternative to Original Medicare, but you still have Original Medicare coverage.
​​​​What’s the difference between MAPD and MA-only plans?
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MAPD (Medicare Advantage Prescription Drug) plans include both medical and prescription drug coverage. MA-only plans provide medical coverage but do not include prescription drugs.
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Can I use Medicare Advantage if I’m under 65 and on disability?
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Yes, if you are under 65 and have been receiving disability benefits for 24 months, you are eligible to enroll in a Medicare Advantage plan.
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What does Medicare Advantage cover that Original Medicare doesn’t?
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Medicare Advantage may cover additional benefits like routine dental, vision, hearing, wellness services, and fitness programs like SilverSneakers, which Original Medicare doesn’t cover.
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Are second opinions covered by Medicare Advantage plans?
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Yes, second opinions are generally covered under Medicare Advantage plans, but you should check with your plan for any specific rules or requirements.
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What is the coverage area or service area for a Medicare Advantage plan?
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The coverage area for a Medicare Advantage plan is the geographic region where the plan’s network of doctors and facilities is available. You must live in the plan’s service area to join.
2. Cost and Premiums
How much will I pay monthly for a Medicare Advantage plan (premium, copays, max out-of-pocket)?
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The cost depends on the plan. You will still need to pay your Part B premium. Medicare Advantage plans may have a separate premium, and you may also have copays and coinsurance. Plans have a yearly out-of-pocket maximum to limit your costs.
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Do I still have to pay the Medicare Part B premium with Medicare Advantage?
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Yes, you must still pay the Medicare Part B premium, even if you are enrolled in a Medicare Advantage plan.
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Are there $0 premium Medicare Advantage plans, and are they really free?
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Some plans have a $0 monthly premium, but you may still need to pay the Part B premium and other costs like copays or coinsurance. These plans are not “free,” but they have no additional monthly premium.
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What’s the annual out-of-pocket maximum for Medicare Advantage plans?
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Medicare Advantage plans have a yearly out-of-pocket maximum. This limit helps protect you from high healthcare costs. The amount varies by plan but is capped annually.
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Are there penalties if I switch from Medicare Advantage to Original Medicare?
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There are no penalties for switching from Medicare Advantage to Original Medicare, but you may have to pay higher premiums for Part B and Part D if you delay enrollment.
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3. Prescription Drug Coverage (Part D)
Does Medicare Advantage include prescription drug coverage (Part D)?
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Most Medicare Advantage plans (MAPD) include prescription drug coverage, but some plans do not. If your plan does not include drug coverage, you can join a standalone Part D plan.
​​Are vaccines and immunizations covered by Medicare Advantage?
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Medicare Advantage plans must cover vaccines and immunizations that are covered by Original Medicare, like the flu shot. Some plans may offer additional vaccines.
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How do I find out if my prescriptions are covered under my plan?
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You can check your plan’s formulary, which is the list of covered drugs, or use the plan’s online tool to see if your medications are covered.
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What happens if my drugs are not covered under my plan?
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If your drugs are not covered, you can request an exception, switch to a plan that covers your drugs, or join a standalone Part D plan if your Medicare Advantage plan doesn’t include drug coverage.
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What is a Medicare Advantage plan’s formulary?
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A formulary is a list of drugs that your Medicare Advantage plan covers. It includes information on which medications are covered and the costs associated with them.
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4. Extra Benefits
​​​Are dental, vision, and hearing benefits included in Medicare Advantage plans?
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Many Medicare Advantage plans include coverage for dental, vision, and hearing. However, coverage varies by plan, so it's important to check what’s offered in each plan.
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Is SilverSneakers or gym membership included in my plan?
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Many Medicare Advantage plans include SilverSneakers or other fitness programs, but coverage varies by plan.
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What’s included in wellness benefits or preventive care in Medicare Advantage?
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Medicare Advantage plans must cover certain preventive services, like screenings and vaccinations, and may offer additional wellness benefits such as fitness programs and health assessments.
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Can I get rides to the doctor with Medicare Advantage?
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Some Medicare Advantage plans offer transportation benefits, including rides to doctor’s appointments, but availability depends on the specific plan.
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Are there Medicare Advantage plans with caregiver support or respite care?
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Some Medicare Advantage plans offer additional benefits for caregivers, such as respite care or support services, but these vary by plan.
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What are “extra benefits” in Medicare Advantage, and how do I use them?
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Extra benefits are additional services that some Medicare Advantage plans offer, like fitness programs, dental care, or vision coverage. You can use these benefits by following the plan's guidelines.
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Are home health services covered under Medicare Advantage?
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Yes, Medicare Advantage plans must cover home health services, but the coverage may vary. Check with your plan for specific details.
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Are mental health and counseling covered under Medicare Advantage?
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Yes, Medicare Advantage plans must cover mental health services, including counseling and therapy, but the specific coverage may vary by plan.
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5. Doctors and Networks
Can I keep my doctor with a Medicare Advantage plan?
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If you have an HMO plan, you may need to use a network of doctors and get referrals for specialists. PPO plans offer more flexibility to see out-of-network doctors, but at a higher cost. Always check the provider network for your specific plan.
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What happens if my Medicare Advantage plan drops my doctor or hospital mid-year?
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If your doctor or hospital is dropped from your plan, you may need to find a new provider. If this disrupts your care, you may be eligible for a Special Enrollment Period to change plans.
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6. Plan Types (HMO, PPO, etc.)
What types of Medicare Advantage plans are available (HMO, PPO, etc.)?
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Medicare Advantage plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNPs), and HMO Point of Service (HMOPOS).
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What is the difference between an HMO and a PPO Medicare Advantage plan?
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HMO plans require you to use a network of doctors and get referrals for specialists. PPO plans provide more flexibility to see out-of-network providers, but at a higher cost.
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7. Enrollment and Switching Plans
What are Special Enrollment Periods for Medicare Advantage?
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Special Enrollment Periods (SEPs) allow you to make changes to your Medicare Advantage plan outside of the standard enrollment periods. SEPs are available if you experience certain life events, such as moving or losing other coverage.
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When can I enroll in or switch my Medicare Advantage plan?
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You can enroll or make changes during the Annual Election Period (October 15–December 7). You may also be eligible for a Special Enrollment Period if you qualify for certain circumstances (e.g., moving).
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Can I switch back to Original Medicare if I don’t like Medicare Advantage?
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Yes, you can switch back to Original Medicare during the Medicare Advantage Disenrollment Period (January 1–March 31) or during the Annual Election Period (October 15–December 7).
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Can I change my Medicare Advantage plan every year?
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Yes, you can change your Medicare Advantage plan each year during the Annual Election Period (AEP), or during a Special Enrollment Period if you qualify for one.
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How do I compare Medicare Advantage plans in my area?
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Use the Medicare Plan Finder on the Medicare website to compare available Medicare Advantage plans in your area based on coverage, costs, and ratings.
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Can I switch from one Medicare Advantage plan to another mid-year?
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You can switch from one Medicare Advantage plan to another only during certain periods, like the Annual Election Period or Medicare Advantage Open Enrollment Period.
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​Can I enroll online or do I need an agent?
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You can enroll in Medicare Advantage online through the Medicare website, or you can work with a licensed agent to help you through the process.
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What is the Medicare Advantage Disenrollment Period, and how does it work?
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The Medicare Advantage Disenrollment Period runs from January 1–March 31. During this time, you can disenroll from your Medicare Advantage plan and switch back to Original Medicare.
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Can I get a free Medicare Advantage plan comparison?
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Yes, you can use the Medicare Plan Finder tool on the Medicare website to compare Medicare Advantage plans for free.
What is the Medicare Advantage Open Enrollment Period?
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The Medicare Advantage Open Enrollment Period is from January 1–March 31 each year, during which you can switch Medicare Advantage plans or return to Original Medicare.
How long does it take for coverage to start after enrollment?
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Coverage typically starts on the first day of the month after your enrollment is processed.
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8. Travel & Moving
​​What happens if I travel or move with Medicare Advantage?
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If you travel, your coverage may be limited to emergency and urgent care. For routine care, you might not be covered outside the service area of your plan. If you move, you can switch to a plan in your new area.
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Does Medicare Advantage cover emergency care out of state?
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Yes, Medicare Advantage plans generally cover emergency care when you are outside your plan’s service area, but routine care may not be covered.
9. Special Needs Plans (SNPs)
​​​​How does Medicare Advantage handle chronic conditions like diabetes or COPD?
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Medicare Advantage plans often have special programs for managing chronic conditions like diabetes and COPD, offering care coordination and disease management services.
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​​Are there Medicare Advantage plans for people with low income?
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Yes, there are plans for people with low income, such as the Low-Income Subsidy (LIS) or Special Needs Plans (SNPs), which may offer extra benefits and lower costs.
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Are there dual-eligible plans for people with Medicare and Medicaid?
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Yes, there are Dual Special Needs Plans (DSNPs) for people who are eligible for both Medicare and Medicaid. These plans often have additional benefits.
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Are over-the-counter (OTC) items included in my plan?
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Some Medicare Advantage plans offer an OTC allowance, which covers certain over-the-counter items like vitamins, pain relievers, and other healthcare products.
10. Coverage Limits & Rules
​​​​​​​​​Can I have TRICARE or VA benefits with Medicare Advantage?
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Yes, if you have TRICARE or VA benefits, you can still enroll in a Medicare Advantage plan, but you must consider how the benefits work together and how they impact costs.
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How do I cancel my Medicare Advantage plan?
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To cancel your plan, contact your Medicare Advantage insurer. You may be able to switch to another plan during the Annual Election Period or a Special Enrollment Period.
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Can I keep the same plan when I move to a new state?
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You may need to switch plans if you move to a new state because Medicare Advantage plans are often state-specific. Contact your plan for options.
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What happens if my Medicare Advantage plan leaves my area?
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If your plan leaves your area, you will receive notice and may need to switch to another Medicare Advantage plan available in your new location.
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What happens if I join a Medicare Advantage plan and don’t like it?
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You can switch to a different Medicare Advantage plan during the Annual Election Period or the Medicare Advantage Disenrollment Period if you are not happy with your plan.
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How do I report fraud in Medicare Advantage?
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You can report Medicare fraud to Medicare by calling 1-800-MEDICARE (1-800-633-4227) or by visiting the Medicare website.
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How do I file a claim or appeal a coverage decision?
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To file a claim, contact your plan. If you disagree with a decision, you can appeal by following the process outlined by your plan, which includes a series of steps for formal reviews.
11. Other Questions​​​​
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Does Medicare Advantage cover urgent care and telehealth visits?
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Yes, most Medicare Advantage plans cover urgent care and telehealth services, but you should check with your plan for details on coverage.
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Can I use a Health Savings Account (HSA) with Medicare Advantage?
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No, you cannot contribute to an HSA once you are enrolled in Medicare. However, you can still use the funds in your HSA for qualified medical expenses.
How do star ratings work for Medicare Advantage plans?
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Medicare rates plans on a scale from 1 to 5 stars based on the quality of care and customer service. Higher ratings indicate better overall quality.
​What is prior authorization, and how does it affect me?
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Prior authorization means your plan requires approval before you receive certain services or medications. If you don’t get approval, the plan may not cover the service.
​​​Does Medicare Advantage cover nursing home or long-term care?
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No, Medicare Advantage plans do not cover long-term care or custodial care. However, they may cover short-term stays in a skilled nursing facility after a qualifying hospital stay.
Can I have a Medicare Supplement (Medigap) and a Medicare Advantage plan together?
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No, you cannot have both a Medicare Supplement (Medigap) and a Medicare Advantage plan at the same time. You must choose one or the other.
What is the 5-star Medicare plan enrollment rule?
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If you enroll in a 5-star rated Medicare Advantage plan, you can switch to that plan at any time during the year, as long as the plan is available in your area.
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What is the “trial right” period for Medicare Advantage?
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The trial right period allows you to return to Original Medicare within the first year of enrolling in a Medicare Advantage plan without penalty if you don’t like the plan.
Can I be denied coverage by a Medicare Advantage plan?
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Generally, you cannot be denied coverage due to pre-existing conditions. However, you must meet certain eligibility requirements, and plans may have network restrictions.
What’s the difference between in-network and out-of-network costs?
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In-network providers have agreements with your plan, and you usually pay lower costs for their services. Out-of-network providers may charge higher costs and may not be covered at all under some plans.
How do I report a billing error with my Medicare Advantage plan?
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If you believe there is a billing error, contact your plan directly. They will guide you through the process of correcting the mistake.
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What is the maximum drug cost I’ll pay each year with a Medicare Advantage plan?
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There is a maximum out-of-pocket cost for prescription drugs, which varies depending on the plan. This amount is capped annually to protect you from high costs.
What are Special Needs Plans (SNPs) and do I qualify?
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SNPs are Medicare Advantage plans designed for people with specific health conditions, such as chronic diseases, or for those who are eligible for both Medicare and Medicaid.
How do Medicare Advantage plans make money?
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Medicare Advantage plans are paid by the federal government to provide coverage for Medicare beneficiaries. The plans can also receive additional payments based on the health status of their members.
What are Dual Special Needs Plans (DSNPs)?
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DSNPs are Special Needs Plans for people who are eligible for both Medicare and Medicaid. They provide coordinated care for individuals with specific needs.
​Can I add dental or vision benefits to my Medicare Advantage plan?
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Some Medicare Advantage plans offer dental and vision coverage as part of the plan. You can also choose a plan that includes these benefits.
How do I know if Medicare Advantage is the best option for me?
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To determine if Medicare Advantage is the best option, compare the available plans in your area based on your healthcare needs, budget, and preferred doctors or hospitals.
How do I find a plan’s provider directory?
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You can find a plan’s provider directory on the plan’s website or by contacting the plan directly for a copy of the list of in-network providers.
What are SNPs (Special Needs Plans) and how do I qualify?
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SNPs are Medicare Advantage plans designed for individuals with specific needs, such as chronic conditions or eligibility for both Medicare and Medicaid. To qualify, you must meet the eligibility criteria.
Is a Health Risk Assessment required for enrollment in a Medicare Advantage plan?
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Some Medicare Advantage plans require a Health Risk Assessment (HRA) as part of their enrollment process to help understand your health needs and care options.
Can my spouse join the same Medicare Advantage plan?
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If your spouse is also eligible for Medicare, they can join the same plan, but they must meet eligibility requirements and the plan’s service area.
How often can I get a free check-up or physical under Medicare Advantage?
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Medicare Advantage plans must cover an annual wellness visit, which includes screenings and preventive services.
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