Medicare Advantage Plans
As a Medicare Beneficiary, you have two ways to receive your Medicare benefits; 1. Directly through the government (Original Medicare). 2. From a private plan available in your area. Medicare Advantage, also known as “Part C”, are health plans provided by private insurance carriers. Medicare Advantage plans do not supplement your Medicare, they become it. Medicare Advantage Plans provide the same medical benefits as Original Medicare, but will usually include extra coverage. These extra’s can include prescription, dental, vision, and fitness club benefits. Medicare Advantage plans will also include manageable co-pays for medical care with caps on your annual out of pocket. Things that regular Medicare doesn’t provide. The good news is that in many cases you can get all of these benefits for little or no extra monthly premium than what you’ll pay for Medicare.
Medicare Advantage Benefits
Extra Benefits Included
Medicare Advantage includes medical benefits under parts A & B and may also include prescription, dental, vision, hearing, & other benefits. All in one plan.
Financial Protection
With Medicare Advantage you can access medical care for reasonable copays and you’ll have limits to the amount you spend on medical care.
Low Monthly Cost
You can get the extra benefits included with Medicare Advantage, for little or no extra monthly cost. Typically you only pay the standard monthly cost of Medicare, sometimes less.
Medicare Advantage Plan Types
Medicare Advantage Plans have networks, which are lists of doctors and hospitals who participate in the plan. These networks can give Medicare Advantage members convenient access to medical care at reasonable costs. There are various types of Medicare Advantage Plans and the two most common are HMO’s and PPO’s. Here are the key features and differences between the two types of plans.
PPO – Preferred Provider Organization
- Has a network of preferred doctors & hospitals, usually nationwide.
- The plan is flexible and allows you use out of network doctors, but for higher co-pays than in network.
- You are covered anywhere in the event of an emergency or urgent care situation.
- No referrals are needed to see a specialist doctor.
- Best if you travel or want more flexibility and choice with seeing healthcare providers.
HMO – Health Maintenance Organization
- Has a local, multi county, network of preferred doctors & hospitals.
- You need to use this network of doctors & hospitals for scheduled medical care.
- You are covered anywhere in the event of an emergency or urgent care situation.
- You will need a referral to see a specialist doctor.
- Best if you want the most benefits at the lowest cost and are good with using the plan’s doctors and other rules.
Medicare Advantage Vs Original Medicare
As mentioned above, you have two ways to receive your primary Medicare benefits; Medicare Advantage and Original Medicare. The chart below gives you a comparison of the main features.
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Total Monthly Cost Estimate | $164.90 in 2023 | $104.90 – $164.90 in 2023 |
| Part A & B Medical Included? | Yes | Yes |
| Cap On Annual Medical Bills Included (Max out of pocket protection) | No, you can buy a Medicare Supplement (Medigap) | Yes |
| Doctor Networks | No – Open | Yes |
| Pharmacy Benefits (Part D)? | No, you can buy a Part D plan. | Yes, Part D is usually included, unless you choose a plan without it. |
| Dental, Vision, Hearing | No | Yes, typically included. |
| Fitness Membership | No | Yes |
Sample Medicare Advantage Plan
What A Typical Medicare Advantage Plan Can Look Like
| Benefit | Copay Or Allowance |
|---|---|
| Annual Deductible | $0 |
| Preventive Medicine | $0 copays |
| Doctor Visits | $5 Copay Primary Care $30 Copay Specialist |
| Outpatient Surgery & Procedures | $150 – $300 copay |
| Hospital Stay | $100 – $300 copay per day for days 1-5, $0 copay each day above 5 |
| In Network Max Out Of Pocket Protection (The most you pay for medical care annually) | $3,400 – $6,700 |
| Pharmacy Benefits (Part D)? | Generic: $0 deductible / $0 – $10 copay Brand: $0 – $200 deductible / $40 copay |
| Dental | Coverage for cleanings, fillings, crowns, dentures, and other services, $2,000 – $3,000 in annual benefits |
| Vision | $0 cost annual eye exam, $200 allowance for eye glasses or contacts. |
| Hearing | $0 cost annual hearing exam, allowance or copay for hearing aids. |
| Gym / Fitness | Silver Sneakers membership for free access to participating gyms |
| Other Possible Benefits | Over the counter medicine & vitamins, flex spending cards, transportation. |
*The benefits and comparisons listed in the two charts above are for general information purposes. They do not represent specific plans and benefits are not guaranteed. For plans you are considering, review the Summary of Benefits and Evidence of Coverage. Contact us for specific plan options available to you.
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Who Can Benefit From Medicare Advantage?
Medicare recipients who want the most value from Medicare and lowest monthly cost.
Veterans, Retired Military, & Their Families can benefit from plans specially designed for them. Plus, Medicare Advantage works with Tricare & CHAMPVA.
Those receiving Medicare from disability and are under age 65.
Medicare recipients who are moderate to low income and / or have Medicaid.
Medicare Advantage Frequently Asked Questions
When can I sign up for a Medicare Advantage Plan?
There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th. There may also be other special situations that make you eligible. To get information and enroll in a plan, simply contact us on this site or give us a call at 855.625.7633 toll free.
How do I sign up for a Medicare Advantage plan? To enroll in a Medicare Advantage plan you must be registered for Medicare A & B now or 3 months in the future. To get information on and enroll in a plan, just call us at 1.855.625.7633 or contact us on this site. We’ll give you the details and guidance and help you enroll right over the phone.
Will Medicare Advantage and it’s extra benefits cost me more monthly? In most cases no. The nice thing about Medicare Advantage is that you can get extra benefits included, for no extra monthly cost. In fact, in some cases you can get the extra benefits and a lower overall monthly cost.
How does Medicare Advantage provide extra benefits for no extra monthly cost? When you sign up for a Medicare Advantage plan it is provided by a private insurance company and it becomes your Medicare benefits. The government then pays your Medicare Advantage provider a monthly amount to provide you with benefits. The government pays them more than the average to allow for the extra coverage. Plus, Insurance providers are already efficient at providing extra benefits (dental, vision, hearing, etc), so they’re able to include them for no extra cost.
Will having Medicare Advantage lower the quality of my coverage or care? No. Medicare Advantage is regulated by the federal government and it provides coverage for medically necessary treatment. Many covered services are subject to approval by the insurer and are typically approved without issue. The quality of doctor & hospital networks can vary with different plans and insurers. So, it’s important to choose a quality insurance provider that meets your individual needs.
If I sign up for Medicare Advantage, can I keep my doctors or will I need to change them? In most cases, you will be able to keep seeing them. Medicare Advantage plans have networks, meaning a list of doctors and hospitals that are accept the plan. Some Medicare Advantage plans allow you to go out of network, to any doctor, but for potentially higher copays. When evaluating a Medicare Advantage plan, you should check if your doctors and medical providers accept the plan and choose a plan that does. If you’re working with us, this is something that we will do for you.
If I enroll in a Medicare Advantage plan, can I change to another one or go back to regular Medicare? Yes. Each year from October 15th through December 7th, you can change your Medicare Advantage plan to another. Also, from January 1st through March 31st each year, you can dis-enroll from a Medicare Advantage plan and go back to Original Medicare.
