Medicare Advantage

A Medicare Advantage (MA) plan is a private health insurance plan approved by Medicare. You may opt to get your Part A, B, and D benefits from a Medicare Advantage plan instead of traditional Medicare. These Medicare private insurance plans usually have an HMO or PPO network of doctors. 
 
Medicare Advantage Explained
Medicare Advantage plans were created as an alternative to Original Medicare and Medigap. By joining one of these plans, you direct Medicare to pay the Advantage plan a set monthly amount for your care. In return, the plan will deliver all of your Part A & Part B services. They take on all of your medical risks. You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan. You must be enrolled in both Medicare Parts A and B and live in the plan’s service area. Medicare Advantage policies are NOT Medigap plans. They work differently because they pay instead of Medicare, not after Medicare.  

Medicare Advantage Coverage
Many people new to Medicare will ask about the pros and cons of Medicare Advantage plans vs Original Medicare.  Much of this is in the way you access your healthcare.

With Original Medicare, you will have deductibles and a 20% coinsurance on Part B. You can visit any doctor or hospital that participates in Medicare, and most do.

With an Advantage plan, you will use the plan’s network of providers, which is usually local. You will pay co-payments when you receive healthcare services. Each plan sets its own cost-sharing. For example, you might pay a small copay for a primary care doctor visit and perhaps a higher copay to see a specialist. Likewise, some plans will charge you a daily hospital copay, and other plans might charge a flat amount for the whole stay.

Perhaps one of the biggest differences is in changes to the plans. Medicare may have small changes to the Part A and B deductible, but the 20% coverage on outpatient services never changes. Part C Medicare Advantage plans change annually.  Medicare itself states: Limitations, co-payments, and restrictions may apply, and each plan’s, formulary, pharmacy network, provider network, cost share, and co-payments may change on January 1 of each year.  Members need to be diligent about reviewing the plan materials sent to them each year in September to see what’s changing.