Medicare Advantage Explained
Medicare Advantage (MA) are health plans provided by private insurance companies who have a contract with Medicare. The private company receives a set amount of money from the government, in exchange for providing health coverage.
The plans that they design must have at least the same coverage Medicare Provides. You are still "on Medicare," but it now becomes the insurance company that is paying the provider and not Medicare.
Medicare Advantage Coverage
With a MA plan, you will receive your care from a provider network and must live in the service area. If you were to get services outside of this network, (except for emergency or urgent care) you may incur a higher cost. Many plans now offer coverage throughout the country if you are out of your service area temporarily. You would still be required to use an in network provider in the area you are staying.
There are only certain times of the year or certain circumstances in which you may change your plan. You must also be enrolled in Part A and B, and continue paying your Part B premium.
Medicare Advantage Costs
Most Medicare Advantage plans offer a low or $0 premium option. In addition, there may not be a deductible. There are also no pre-existing conditions rules.
Medicare Advantage has the ability to bundle services. Plans can include drug coverage and also dental, vision, and hearing benefits. Some plans even offer extras like a fitness benefit or medical transportation.
If you’re familiar with employer insurance, or Health Marketplace insurance, these plans are similar in that you pay for services as you use the plan. For example: if you see a doctor, you may have a copay—if you have other services, there could be coinsurance. All plans are required to have a maximum out-of-pocket limit for medical expenses. The drug coverage portion has a separate catastrophic protection structure.
How to Choose a Medicare Advantage Plan
If you’re thinking about selecting a Medicare Advantage plan, there are a few important things to consider:
1
Are your preferred doctors (primary care, specialists, etc.) in the plan’s provider network?
2
Are your medications in the formulary? What about your preferred pharmacies?
3
Are there extra benefits included that are especially important to you? This would include dental, hearing, and vision.
4
Are you comfortable with the maximum out-of-pocket cost level and the amount you will have to be responsible for?
5
Are you currently on Medicaid, or do you qualify for financial assistance?
This list is not all-inclusive, but should give you a good idea as to what you should look for to make sure you choose the correct plan. Working with an independent agent is a great way to make sure you’ve got all of these details in order, and it gives you someone to turn to anytime you have questions or need to make changes.
Medicare Supplements VS. Medicare Advantage
There are two ways to add additional coverage that can cover gaps that your Medicare may not take care of. Learn more about the differences between Medicare Supplements and Medicare Advantage with our helpful guide.
Do you still have questions? Take a look at our Medicare Basics outline, or give us a call at 931-287-0799.
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**This is a personal website of Steve Walter and is not associated with or endorsed by any government agency. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 56 products in your area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program to get information on all of your options.