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Medicare Advantage Plans
What is Medicare Advantage?
Let's get started! Medicare Advantage, also less commonly Medicare Part C, are private Medicare health insurance plans which bundle Medicare Parts A + B and typically Part D rx as well.
What are the different types of Medicare Advantage plans?
HMO: If your current doctor, medical group, and hospital are contracted with a Medicare Advantage HMO plan you may want to consider this path, as sometimes these Advantage HMO plans can be $0 in monthly premiums so may have less expenses out of pocket.
PPO: With PPO Medicare Advantage you get the benefit of the health insurance carrier contracted provider list, which gives access to a much greater number of doctors. You can also seek medical care out of network but pay more out of pocket if the provider agrees to accept Medicare.
Other types of Medicare Advantage plans: SNP, MSA, POS.
There are much less common Medicare Advantage plans available at some insurance carriers option which may suit particular situations.
Special Needs Plans: Special Needs Plans are Medicare Advantage plans which offer coverage to only individuals with specific medical conditions, like end stage renal disease, chronic heart failure, HIV/AIDS, etc..
MSA: Medical Savings Accounts provide tax deductible dollars in pre tax accounts for qualified medical expenses, similar to the very popular HSA Health Savings Account strategy for pre-65 individuals
POS: Medicare Advantage ’‘Point of Service’ plans are Medicare Advantage HMO plans which give an option to utilize out of network or out of area services in certain medical situations, choosing to pay more out of pocket
Why would you want a Medicare Advantage Plan?
Medicare Advantage Plans are required to offer at least the same level of coverage as Original Medicare, but can offer additional benefits such as prescription drugs, dental, or vision care. Some Medicare Advantage plans offer wellness care. Anthem Blue Cross has a plan which even offers coverage for hearing aids which are not covered in Original Medicare.
What are the disadvantages?
Medicare Advantage Plans offer coverage primarily through the private insurance carrier contracted providers (doctors, hospitals, etc..) within the county. Original Medicare offers coverage at all providers who accept Medicare nationwide.
Medicare Supplements also cover the majority of treatments covered by Original Medicare. For example, if your Medicare Supplement F plan has a $0 co-pay for a routine lab, and Original Medicare allows/pays on the claim then the supplement will kick in and pay on your behalf.
What does it cost?
In the end, cost isn’t always THE factor, but it’s certainly always A factor! Medicare Advantage plans run typically between $0-$100 monthly (plus the monthly premium cost of Medicare Part B) for turning 65. Often times if cost is the main factor, and you’re willing to give up some doctor access and control of your medical treatment, then Medicare Advantage is a good solution.
Why would the Federal Government privatize Medicare entirely? I don’t understand why there is a separate Medicare program.
Back in 2003 the federal government addressed primarily the gap in missing prescription drug coverage Medicare, through the passage of the Medicare Modernization Act. As a small piece of the legislation, the Feds were looking for ways to reduce the costs of the Traditional Medicare program. This came in the form a of health plan privatization program or Medicare Advantage as we know it.
Can you change your Medicare Advantage plan anytime?
Medicare does give you what amounts to essentially a free look period where if you enroll in Medicare Advantage during your initial eligibility period, where within the first 12 months you can disenroll and place coverage with Original Medicare and a Supplement with Part D Rx.
Medicare Advantage does have an Open Enrollment window, where you can request a carrier or plan change to another Medicare Advantage plan. The open enrollment runs each year from October 15th to December 7th. This includes the Prescription Drug plans as well.
Can you change from Medicare Advantage to a Medicare Supplement plan?
You can also submit an application to request a change to a Medicare Supplement plan, but the switch is not guaranteed to be approved (can be declined due to medical conditions). This request must be timed carefully so you can utilize the Medicare advantage disenrollment period which falls on Jan 1st to Feb 14th each year.
Isn’t Obamacare defunding the Medicare Advantage program to pay for the Affordable Care Act?
How to Compare Medicare Advantage plans
If you've decided you're headed towards a Medicare Advantage plan, now what? How do you decide to pick the right one for you? The next step of course is evaluating the Medicare Advantage plans.
Not all Medicare advantage plans are the same, unlike Original Medicare the healtlh insurance carriers can add additional benefits.
Provider Network: Check each plan's doctor, hospital, and medical group network first. What good is a health plan if you can't see your doctors? You can use the Provider Search tool on our website or Contact Us and we will help you verify them.
This is a huge factor, as for example we see Medicare Advantage plans with premium hospitals contracted in the $100 per month range, while more affordable hospitals keep the premiums down to $0-$25 monthly range.
Ask an Agent Q&A
Michelle V., Long Beach CA
Q. How will we know if our doctors take a Medicare Advantage plan?
Agent Answer. It is crucial to check on your doctors & Hospitals contracted status prior to enrolling in the plan. You can check their status online here, or email us their names and we will search for you.
George B., Los Gatos, CA
Q. What are some added benefits some of the Medicare Advantage plans add beyond traditional Medicare?
Agent Answer. Medicare Advantage plans are allowed to add additional plan benefits to coverage beyond Original Medicare. Some of the health carries have added benefits or riders such as dental, vision, hearing, and fitness membership programs.
For example, some of the UnitedHealthcare Medicare Advantage plans Part C, which is one of the most popular Medicare insurance carrier plans in the nation offers routine vision, dental, and hearing coverage.
Manuel P. Costa Mesa, CA
Q. I'm turning 65 and new to switching to Medicare. Really, it's overwhelming, I don't understand all this stuff and I just don't want to blow it and mess it up.
Agent Answer. Feel free to give us a call Manuel to talk your situation through. We will advise you on the best options for you! 1-866-486-6551.
Victoria M. Visailia, CA
Q. I take a bunch of medications for diabetes. Can you help me figure out which is the cheapest coverage and still keep all my prescriptions?
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Andrew S., Galt, CA
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Joan F., Sacramento
I retired and had no idea how to switch to Medicare. You were a life saver!