Medicare Advantage: What is it?
With Annual Open Enrollment (AEP) right around the corner, it’s important to understand all your options.
Whether you are already on a Medicare Advantage Plan, Original Medicare only, or a Medigap plan, knowing the plan types clarifies if your plan is right for you.
In order to explain Medicare Advantage, I’m going to walk you through the simple explanation I give when I meet with prospective enrollees. (This is a very simplified version; please see the publication Medicare & You for a full breakdown of your Medicare Benefits).
Medicare Review
There are 4 Parts to Medicare: A, B, C, & D
Medicare Part A = Hospital coverage.
Hospital coverage means “Inpatient,” or being actually admitted to the hospital. You pay $1132 per hospital visit.
Medicare Part B = Doctor coverage.
This also includes “Outpatient” coverage, or any surgical procedure that does not require you to be admitted to the hospital overnight. Chemotherapy is also covered under Medicare Part B. You pay a deductible of $162, then 20%.
Medicare Part C = Medicare Advantage
(A + B = C)
Medicare Advantage is another way of receiving your Medicare Benefits. Instead of Medicare paying claims directly to the doctor, Medicare pays each private insurance company a flat monthly fee to dispense your Medicare benefits through a structured health plan. Medicare Advantage Plans are usually HMOs.
By managing the medicare benefits through an HMO, this can lower costs for the member, often for little to no extra premium.
C usually includes D
Medicare Advantage Plans usually include Part D coverage.
Medicare Part D is prescription coverage. Part D plans must be purchased through private insurance. If you have Original Medicare only, or Original Medicare plus a Supplement (Medigap plan), you must purchase a separate stand-alone drug plan.
Many people like the fact that their prescription drug plan is bundled with their Medicare Advantage Plan.
Reasons to Like Medicare Advantage
Affordability: usually the number one reason people choose Medicare Advantage. Medicare Advantage offers additional coverage over and above Medicare, often for no extra premium.
Part D is included. Most Medicare Advantage plans include Medicare Part D. Stand-alone drug plans usually cost more than Medicare Advantage Premiums.
Some people like HMOs, because they get help managing their health care. The primary doctor tells you what specialists to see, and usually sets up the appointments for you. All of your care and health records are contained within one Health Maintenance Organization.
Cap on annual spending: Medicare Advantage Plans offer an annual “out-of-pocket” maximum for copays and coinsurance. That means there is a cap, or cut-off point to how much you are required to spend in a calendar year. Many people don’t realize that Original Medicare (Parts A & B only), offers no spending cap. Your potential out-of-pocket costs on Medicare alone are unlimited.
(Not all Medicare Advantage Plans are HMO’s – see Freedom Blue for California)
The Benefits of a Medicare Supplement (As an alternate to Advantage Plans)
Medicare Supplements are beneficial for those that do not feel comfortable enrolling in an HMO.
While Medicare Advantage Plans feel more affordable with no or low monthly premium, you do give up some freedom by enrolling in an HMO plan. Also, you can end up spending just as much, or more, as it would cost to pay for Medicare Supplement premiums.
Medicare Supplements enable you to visit any hospital or doctor in the U.S. that accepts Medicare (most do). A referral is never required to see a specialist.
A full coverage plan F starts at $127 for a 65 yr old in San Diego county. (Get a quote for your zip code).
In Summary: What is Medicare Advantage?
Medicare Advantage Plans are an alternate way to receive your Medicare Parts A & B, usually includes Part D, and is offered through private insurance companies.
To learn about plans for California, visit California Medicare Advantage, or California Medicare Supplements.
Questions? Need help?
Call Toll Free 888.520.8683
Pamela Cook
Authorized Independent Agent
CA Insurance 0G04182
{ 0 comments }
