Medicare Advantage

Medicare Part C is also known as Medicare Advantage plans.  These are private health insurance plans approved by Medicare. You may opt to get your Part A, B and D benefits from a Medicare Advantage plan instead of traditional Medicare. These Medicare private insurance plans usually have an HMO or PPO network of doctors.

Medicare Advantage plans were created as an alternative to Original Medicare and Supplement Plans. Medicare pays the Advantage plan a set monthly amount for your care. In return, the plan will deliver all your Part A (inpatient hospital) and Part B (medical) services. You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan. You must be enrolled in both Medicare Parts A and B and live in the plan’s service area.

Medicare Advantage policies are NOT Medigap plans. They work differently because they pay instead of Medicare, not after Medicare.

Medicare Advantage Coverage

Many people new to Medicare will ask us for the pros and cons of Medicare Advantage plans vs Original Medicare. Much of this is in the way you access your benefits.

With Original Medicare, you will have deductibles as well as hospital and medical coinsurance. You may use any doctor or hospital that participates in Medicare.

With an Advantage plan, you will use the plan’s network of providers, which is usually local or regional.  You will have copayments when you receive healthcare services. Each plan sets its own cost-sharing. For example, you might pay a small copay for a primary care doctor visit, and perhaps a higher copay to see a specialist. Likewise, some plans will charge you a daily hospital copay, and other plans might charge a flat amount for the whole stay.

Medicare Advantage plans change annually.  Members need to be diligent about reviewing the plan materials sent to them each year in September to see what’s changing.

Advantage plans also have an out-of-pocket maximum cap on your medical spending. Think of this as a safety net. If you have heavy health spending that results in a certain out-of-pocket limit, then the plan kicks in and pays the rest for the remainder of the calendar year.  Part D Prescription Drug expenses are not counted towards the out-of-pocket cap.

Another popular feature of Advantage plans is that they often include a Medicare Part D drug plan, which saves you from having to purchase one separately.

Advantage plans have different networks, premiums, and cost sharing. Working with an insurance agency that specializes in these plans is a great way to ensure that you consider all the variables before choosing your insurance company. Our team is very familiar with how Medicare Advantage plans work.

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We are here to help!

We understand how confusing this may be, and we are here to help. Schedule a counseling session with one of our trusted advisors. During this session, your advisor will explain how Medicare works, what actions you need to take, costs and more.

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