Do You Need Medicare Part B with an Advantage Plan?

Understanding Medicare can feel overwhelming, especially when it comes to deciding whether you need Medicare Part B with a Medicare Advantage Plan. At Mountaintop Insurance Solutions, located in Bend, Oregon, we're here to help you make informed decisions about your Medicare coverage. If you have questions, don't hesitate to call us at (541) 641-8886.

Understanding Medicare and Medicare Advantage

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare, offering additional benefits.

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). It helps cover inpatient and outpatient care but does not include prescription drug coverage.
Medicare Advantage Plans are offered by private companies approved by Medicare. These plans include all benefits and services covered under Part A and Part B, and many Medicare Advantage Plans also include Part D for prescription drug coverage.

Difference Between Original Medicare and Medicare Advantage Plans

The main difference between Original Medicare and Medicare Advantage Plans is the way benefits are delivered. Original Medicare is provided directly by the federal government, while Medicare Advantage Plans are offered by private insurers.

Original Medicare allows you to visit any doctor or hospital that accepts Medicare.
Medicare Advantage Plans often require you to use a network of doctors and hospitals.
Medicare Advantage Plans sometimes offer extra benefits such as vision, hearing, dental, and wellness programs.

Do You Need Part B with a Medicare Advantage Plan?

Yes, to enroll in a Medicare Advantage Plan, you must have both Medicare Part A and Part B. Despite being enrolled in a Medicare Advantage Plan, you still need to pay your Part B premium. Medicare Advantage Plans often provide additional benefits not covered by Original Medicare, but the plan you choose will determine your exact coverage.

Costs: Premiums, Deductibles, and Out-of-Pocket Expenses

Understanding the costs associated with Medicare Advantage is crucial. Here’s what you should know:

The monthly premium for Medicare Part B is mandatory, even if you have a Medicare Advantage Plan.
Many Medicare Advantage Plans have their own premiums, deductibles, and out-of-pocket costs.
Some plans offer low or zero premiums, but keep in mind that this might result in higher out-of-pocket costs.
Each plan has a maximum out-of-pocket limit for Part A and Part B services, which can protect you from high costs.

Enrollment and Choosing a Medicare Advantage Plan

Choosing a Medicare Advantage Plan requires careful consideration. Here's what you need to know:

Medicare Advantage Open Enrollment occurs annually from October 15 to December 7. This is the time to choose or change your Medicare Advantage Plan.
Consider your health needs, the benefits offered by the plan, and the costs involved.
Ensure that your healthcare providers and preferred hospitals are in the plan’s network.

For personalized assistance in choosing the right Medicare Advantage Plan, contact Mountaintop Insurance Solutions at (541) 641-8886.

Supplemental Coverage and Prescription Drug Plans

While many Medicare Advantage Plans include prescription drug coverage, you may also consider supplemental coverage, known as Medigap, to help cover additional out-of-pocket costs.

Medigap policies can help pay for some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
If your Medicare Advantage Plan does not include drug coverage, you might need a separate Part D Plan for prescription drugs.