Medicare Advantage

What is a Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a plan provided by private insurance companies with the help from subsidies provided by the government so that the insurance company can design network based plans at a low or zero premium.

These plans are normally designed with copays and coinsurance throughout the plans as a form of cost share that the client would assume when joining one of these plans. Most plans will include additional benefits at no additional cost to you such as dental, vision, and/or hearing benefits as an example.

So let's take a closer look at Medicare Advantage Plans.

Medicare Advantage Upside:

  • It’s convenient to have a single plan for everything

  • The plan covers everything traditional Medicare covers (hospital insurance and medical insurance) as well as emergency and urgent care

  • Many plans also cover dental care, eyeglasses, and wellness programs

  • Most plans also include prescription drug coverage

  • Your eligibility isn’t affected by health or financial status

  • Premiums are low

Medicare Advantage Down Side:

  • You’re restricted to certain doctors in your network (unless it’s an emergency)

  • Plan premiums can change from year to year

  • Difficult to switch to Medigap later on

  • Plan benefits can change from year to year

  • You’re subject to high deductibles and co-pays that tend to range from $3,400-$6,700

Here are 6 Types of MAPD Plans:

  • Health Maintenance Organization (HMO) plans: In most HMOs, you can only go to doctors in your network (except in an urgent or emergency situation).

  • Preferred Provider Organization (PPO) plans: In a PPO, you pay less if you use doctors in your network. You usually pay more if you go outside of your network.

  • Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor as long as they accept the plan’s payment terms. The plan determines how much it will pay and how much you must pay when you get care.

  • Special Needs Plans (SNPs): SNPs provide specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

  • HMO Point-of-Service (HMOPOS) plans: HMO plans may allow you to get some services out-of-network for a higher copayment or coinsurance.

  • Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.

What do these plans cost?

Cost will vary along with plan type from county to county. The best thing to do is schedule a consultation with us so that we can review which plans are available in your area and determine if the plans available would offer you additional benefits such as dental, vision, and hearing benefits.