Medicare Advantage Plans Explained

Medicare Advantage Plans – Are They Good Or Bad?

You may have been told that Medicare Advantage plans are BAD, or they’re not REALLY free, and you should stay away from these plans. Well the truth is that there are pros and cons with every type of plan. For some people, Medicare Advantage can work very well.

Let’s talk about why a Medicare Advantage plan might make sense for you:

1. If you’re a healthy individual and you don’t have any serious health conditions or any family medical history of chronic disease. You don’t see the Doctor very often and you haven’t had to spend a lot on medical care.
2. If you don’t do much travelling outside of your local area. There may be no need for nationwide coverage.
3. You don’t mind having to see Doctors and Providers inside a plan network. Maybe you’re satisfied with the list of Providers to choose from.
4. Keep your monthly costs low. You don’t mind paying for your medical services as they occur, and you’ll take more risk for any out of pocket expenses that could total up to that annual maximum on the advantage plan.
5. If you would like to have your benefits bundled into one plan and you like the idea that you may be able get some extra benefits with your plan such as dental, vision or a fitness membership. You’re willing to pay more for the other services to have these extra benefits.

If you agree with all 5 of those criteria, then Medicare Advantage may be a good fit for you.

 What Are Medicare Advantage Plans?

Let’s explain in more detail what Medicare Advantage is and two popular types of plans .
Medicare advantage is called Part C of Medicare. These are private health plans that are tightly regulated and funded by Medicare. You’re still in Medicare. The only difference is that the Plan will be administering the Medicare benefits. All claims are filed with the Insurance company, not through Medicare. It’s similar to any group plan you may have had while working.

This is a bundled type of plan where you will still need to have Part A and B. One important note – You will still need to keep paying for your Part B of Medicare even if you choose Medicare Advantage rather than a Medicare Supplement.
Medicare Advantage is not a Medicare Supplement. You can have one or the other, but not both at the same time.

Types Of Medicare Advantage Plans

The most popular Medicare Advantage plans are the HMO and PPO.
The HMO typically has the lowest co-pays. The HMO includes a network of Providers and they don’t include out of network benefits. If you go out of network, you’ll have to pay the bill. They’re regional plans which means you must reside in the service area to be able to enroll in this type of plan. You also may need a referral from your primary care doctor in order to see a specialist.

With the PPO, the co-pays may be a little higher but you have more freedom to see providers outside of the network.  You may have to pay more if you go out of network, either a higher co-pay or percentage of the bill. And with a PPO you don’t need a referral to see a specialist.
With either plan, emergencies are always covered anywhere, but you may not be covered for ongoing care until you get back to your network area. So you want to make sure to check the service area before enrolling in your plan.

Costs Associated With Medicare Advantage Plans

You may find a Medicare Advantage plan that as a ZERO premium per month. This doesn’t mean that all your medical costs will be ZERO. You may have NO or very low copays for some services, but unless you qualify for Government Assistance, you need to know that almost all the plans have costs that you may be responsible for, such as co pays for tests, surgery, and for each DAY that you’re an inpatient in the hospital up to a certain number of days.

The good thing is there’s an annual MAXIMUM out of pocket on each plan that puts a cap on the total amount for your billing. Most Medicare Advantage plans include Part D prescription drug coverage and sometimes there’s extra benefits included in the plan such as dental, vision, health and wellness products, and gym memberships.

It’s important for you to know that benefits can vary from Plan to Plan and also by the county where you live.  Not all types of plans may be available in your area. This is something that we can help you with, we have access to all the plan options nationwide.
So a Medicare advantage plan CAN make sense for some people. We have clients in BOTH types of plans. It just has to makes sense for your situation.