Medicare Advantage (MA)

Also known as Medicare Part C, it’s an alternative to traditional Medicare where private insurance companies offer Medicare benefits. These plans often include additional coverage such as vision, dental, and prescription drugs.

 

Premium

The amount paid monthly to the insurance company for coverage under a Medicare Advantage plan.

 

Deductible

The amount you must pay out-of-pocket before your Medicare Advantage plan begins to cover certain services.

 

Copayment

A fixed amount you pay for covered services, typically due at the time of service (e.g., $20 for a doctor’s visit).

 

Coinsurance

The percentage of the cost of covered services that you pay after you’ve paid your deductible (e.g., you pay 20% of the cost while the insurance covers 80%).

 

Network

The group of doctors, hospitals, pharmacies, and other healthcare providers that have agreed to provide services to members of a specific Medicare Advantage plan.

 

Out-of-pocket maximum

The maximum amount you’ll have to pay for covered services in a plan year, after which the plan covers 100% of covered costs.

 

Annual Enrollment Period (AEP)

The period each year when you can enroll in, switch, or disenroll from Medicare Advantage plans, typically from October 15 to December 7.

 

Special Enrollment Period (SEP)

A time outside the Annual Enrollment Period when you can make changes to your Medicare Advantage coverage due to certain life events, such as moving or losing other coverage.

 

Star Ratings

Medicare evaluates the quality and performance of Medicare Advantage plans using a star rating system ranging from 1 to 5 stars, with 5 being the highest rating. These ratings help beneficiaries compare plan quality and performance.