Medicare Advantage Plans Explained

Medicare Advantage Plans Explained

This post is about Medicare Advantage Plans Explained.  Are you confused about Medicare Advantage plans and how they work? If so, the following post should help clear up any confusion.

Medicare Advantage Plans are insurance plans  offered by private insurance companies.  They are used as an alternative to Original Medicare A and B and/or a Medicare supplement plan.  When you enroll in a Medicare Advantage plan, the doctors/hospitals and other medical providers will bill your Medicare Advantage plan instead of original Medicare.  Medicare Advantage plans are offered by a number of companies such as Anthem BCBS, United Healthcare, Aetna, Connecticare, Etc….  These plans are often offered as $0 premium plans.  This means that you pay nothing per month to enroll in them.

Medicare Advantage plans also include your Medicare Part D drug benefit. (There are some plans that come without the Part D benefit but they usually include it.)  When you enroll in the advantage plan, you use one insurance card for all you care.   You can not enroll in a Medicare Advantage plan and a separate stand alone part D plan.  You also can not enroll in a Medicare Advantage plan and a Medicare Supplement at the same time.

Pros and Cons of a Medicare Advantage plan   (CLICK HERE IF YOU ARE JUST LOOKING FOR AN APPLICATION)

Pros

• The Plan includes your part D drug benefit.
• Many Advantage plans have no monthly premium (You will still pay your Part B premium to Medicare)
• You only need to use one insurance card
• They often have additional benefits such as optional dental,  Full annual physicals, limited eye care, Podiatry and foreign travel benefits.

Cons

• The insurance  company is primary which means the providers need to participate with that company in order to receive care.
• There are co-pays for the medical services you receive.
• The out of pocket limits on the co-pays can be as high as $6,700 per person per year.
• Plan benefits change every January.

Medicare Advantage plans change every January which and the insured needs to be aware of the changes.  What may have been the best Medicare Advantage plan on the market one year may suddenly be the worst choice the next due to benefit changes.   If you enroll in an Advantage plan, you will have the option to change out of one every January.

In general, I suggest Advantage plans to clients that are of relatively sound health and see doctors that participate with this type of plan.  If clients are of poor health or have a number of chronic conditions, I will usually suggest a Medicare Supplement and stand along part D  plan as an alternative.

Here are some quick points regarding Medicare Advantage plans

• They are not medically underwritten which means they can not decline you due to health
• Original Medicare does NOT act as a secondary coverage to a Medicare Advantage plan
• They have networks but the majority of doctors do participate with them.  There are more that do than don’t.
• Medicare Advantage plans are separate from VA coverage.  You can have both a Medicare Advantage plan and still utilize you VA benefits.
• In fact, You can change plans every year.
• You do not need to use a participating doctor or hospital if you have an emergency.

Questions?  Send me an email at Edward@croweandassociates.com  CLICK HERE FOR MEDICARE ADVANTAGE APPLICATIONS