How Do Medicare Advantage Plans Work?

The fact that enrollment in Medicare Advantage has more than doubled in the past seven years makes it obvious that Medicare Advantage, a.k.a. Medicare Part C, is regarded by a growing number of people as a superior alternative to Original Medicare.

As we’ve discussed many times, Medicare Part A and Part B, established in 1965, were never intended to cover anyone’s healthcare expenses in full. Medicare gaps faced by people whose sole health coverage is through Original Medicare Part A and Part B include:

  • The Medicare Part A deductible, currently set at $1,184 per benefit period. Some people have to pay this deductible several times in a single year.
  • Part A copayments, payable to the tune of hundreds of dollars a day starting after your 60th day in the hospital.
  • Part B coinsurance, normally representing 20 percent of your Part B-covered medical costs.

trendsTwo obvious solutions to this problem are Medicare supplement insurance—with 10 Medigap plans tailor-made to suit anyone’s medical history or circumstances—and Medicare Advantage. Medicare Advantage is the solution currently chosen by over 14 million Americans, or about 28 percent of the Medicare population. According to Kaiser Health News, 2013 Medicare Advantage enrollment represents nearly a 10 percent increase from the year before, and a 30 percent increase since 2010.

A Bit of Background about Medicare Advantage

Medicare Part C was established in 1997, 32 years after Original Medicare. First known as Medicare+Choice, Part C became known as Medicare Advantage in 2003.

Medicare Advantage plans are optional Medicare plans offered by private companies approved by Medicare. Part C plans are available to people already enrolled in Medicare Part A and Medicare Part B. Medicare Advantage plans replace Medicare Part A and Part B coverage, and typically offer additional coverage in other areas of health including dental, vision, and hearing. Most Medicare Advantage plans also include prescription drug coverage.

Compare Medicare plans in your area today.

How Do Medicare Advantage Plans Work?

Each month, Medicare pays a fixed amount to the company administering the Medicare Advantage plan you are enrolled in. This fixed amount helps cover your care under the plan.

Instead of requiring you to pay the substantial deductible and coinsurance costs associated with Original Medicare, Medicare Advantage plans often require only modest copayments.

Copay requirements vary widely from plan to plan, however, with some companies using multi-tier copay formulas that may result in higher-than-expected costs for specialist or emergency care.

Because companies selling Medicare Advantage plans are generally free to set their own out-of-pocket requirements and procedures, it is important to avoid assumptions and to be familiar with any rules and requirements associated with any plan you are enrolled in, or are considering enrolling in.

It is also important to be aware that rules and requirements can change from year to year, as can the selection and availability of Medicare Advantage plans within a geographic area.

To summarize all of this, we can safely say that Medicare Advantage is a superior alternative to Original Medicare. However, it is important to investigate all the plans available in your area carefully, and to know exactly what any plan you choose covers and requires.

While Medicare Advantage plans sometimes appear to provide fuller benefits than Medicare supplement plans, they may not actually do so. That’s why it’s important to go over each plan with an expert. Call MedicareMall toll free at 877-413-1556 for help or advice.

While Medicare supplement plans allow you to see any doctor who accepts Medicare, Medicare Advantage plans in many cases may not allow you to do so. Here is where the most popular Medicare Advantage plans stand with regard to letting you go for services or treatment outside your plan’s network:

  • Health Maintenance Organizations (HMOs) normally require referrals from primary care physicians and treatment by hospitals and specialists within the plan’s network.
  • Preferred Provider Organizations (PPOs) are more flexible than HMOs. While PPOs are most cost efficient when you stay within your plan’s network, they provide the option, at additional cost, of using doctors, hospitals, and providers outside the network.
  • Medicare Private Fee-for-Service (PFFS) plans are highly flexible. PFFS plans usually allow you to visit any doctor or hospital Original Medicare would allow you to visit, as long as the doctor or hospital agrees to treat you.

Other Medicare Advantage options include HMO Point of Service (HMOPOS) plans, which allow you to get some services out-of-network for a higher cost; Medicare Medical Savings Account (MSA) plans, which deposit Medicare funds into an account used for paying your health care costs; and Medicare Special Needs Plans (SNPs), which provide focused, specialized healthcare for specific groups of people including beneficiaries of both Medicare and Medicaid, people in nursing homes, and people with certain chronic conditions.

Visit MedicareMall’s handy quotefinder to find the best Medicare Advantage options and rates available in your area.

Medicare Advantage premiums are highly affordable, and many plans are available premium-free. You continue to pay your Medicare Part B premium while enrolled in Medicare Advantage, but have the likelihood of enjoying far more comprehensive coverage at essentially the same cost. It is important, however, to choose a Medicare Advantage plan that will not punish you with hidden costs.

With the exception of hospice care—which Medicare Part A continues to cover regardless of enrollment in Medicare Advantage—Medicare Advantage covers everything Original Medicare covers. But that is just the start. Contact a MedicareMall representative to learn more about where a good Medicare Advantage plan can take you from there.

If you’ve chosen Medicare Advantage as your alternative to Original Medicare, please leave a comment telling us why!

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