Medicare Advantage plans pay for managed health care through private insurance companies.  All Medicare services are billed to the private health plan and are not paid for by Original Medicare.

Typically these plans offer beneficiaries a lower-cost option than Medicare Supplements, but they require the use of network doctors and hospitals through HMO and PPO plan types.

How does Medicare Advantage Work?

Once enrolled in a plan, Medicare pays the plan a monthly fee to provide your managed health care.  You must stay enrolled in Part A & Part B of Original Medicare and continue to pay your Part B premium in addition to the plan premium.

Medicare Advantage plans combine your health coverage and Part D drug coverage into one plan.  Plans will provide the same benefits as Part A and Part B of Original Medicare such as: primary care and specialist doctor visits, hospital stays, surgeries etc.

Every Medicare Advantage plan is different and benefits vary according to the plan and service area.  Each plan has a summary of benefits which describes the plans deductibles, co-payments, coinsurance and out-of-pocket maximums up to $6,700.

Most plans are either a HMO (health maintenance organization) or a PPO (paid provider organization).  HMO’s require the use of in-network doctors and hospitals only.  They also require referrals from your primary care physician to see a specialist.  PPO’s allow the use of in-network and out-of-network providers, and do not require a referral to see a specialist.  Out-of-network providers generally have higher co-payments and the provider must accept the terms of the plan.

Medicare Advantage plans also have specific enrollment periods. Usually, you can only enroll once per year during the Annual Election Period (October 15th-Dec 7th) and you have to keep that plan until the next election period.

Be sure and review the plans with one of our agents to understand each plans benefits throughly before making a decision.

Medigap Vs Medicare Advantage

Another option Medicare beneficiaries have is a Medicare Supplement or Medigap plan.  These plans allow you to see any doctor who accepts Original Medicare A & B.  Medigap plans are not subject to HMO or PPO networks and provide vast comprehensive coverage nationwide.

Medicare Supplements cover most or all of what Original Medicare does not cover.  Plans range in price and are offered by private insurance companies.  Plans usually cost more than Medicare Advantage, but coverage is much more extensive and generally better.

Medigap plans do not offer drug coverage. You will need to sign up for a stand-alone prescription drug plan.  In some cases, stand-alone plans can offer lower co-payments than Medicare Advantage plans.

Medigap plans also provide more coverage for Part B drugs (drugs administered by a doctor) and chemotherapy than Medicare Advantage plans do.  Generally, Advantage plans will cost beneficiaries 20% coinsurance on radiation, chemotherapy and Part B drugs.

Medicare Advantage Pros and Cons

Lets take a look at some pros and cons of Medicare advantage:

Pros:

• Low monthly premiums
• Combines health and drugs into one plan
• Some extra benefits like dental and vision

Cons:

• HMO’s require use doctors and hospitals in the plans network
• Out-of-pocket costs could be up to $6,700
• Can only change plans during specific enrollment periods
• Plans change each year so the plan you had the previous year may not best suit you for the upcoming year
• Some coverage gaps in chemo, radiation and Part B drugs

Is Medicare Advantage right for you?

We wish there was an easy answer to this question.  You, the Medicare beneficiary, will ultimately need to make a informed decision based on which Medicare option is right for you.  But don’t worry, Senior Insurance Services is here to help!  We will take into consideration every concern you have and go over each option step by step to find you a plan that best fits your health care needs!

You can call us toll free 7 days a week up until 9pm CST at 1-800-594-5393 or email us at jonw.insurance@gmail.com or davewind@mac.com.  We look forward to working with you!