Medicare Advantage Plans

Also known as Part C, Private Medicare,

Few things have caused as much confusion in the Healthcare world as the introduction of the Medicare Advantage Plans. Also known as Part C, Medicare Health Plans, MA plans, and MAPD plans, Medicare Advantage plans are relatively new and by the end of the 2007 Annual Enrollment period approximately 25% of Medicare Recipients had enrolled in an MA plan.

To understand Medicare Advantage Plans, it really helps to have a really good understanding of Medicare Supplements and how they work. So, if you have not already done so, you should read our Medicare Supplements section.

What Medicare Advantage Plans Are:

  1. Medicare Advantage plans are alternatives to Original Medicare.
  2. Medicare Advantage Plans are health plans approved by Medicare but run by private companies.
  3. If you join a Medicare Advantage Plan, you are still enrolled in Medicare, but Medicare is no longer your healthcare provider, the Medicare Advantage company is.
  4. Medicare pays an amount of money (we don’t know exactly how much) to these companies each month, and these companies use that money to pay your healthcare bills.
  5. According to the MA’s contract with Medicare, the MA company must provide “at least” as good of coverage as original Medicare.
  6. If you have an MA plan, then when you receive healthcare from your doctor, hospital or other provider, they send the bill to the Medicare Advantage company NOT to Medicare. That is why they tell you to show your MA Membership card, NOT your medicare card. If you do show your Medicare Card, you will almost certainly cause confusion and delays in getting your bills paid.
  7. If you have a Medicare Advantage Plan that is an MAPD instead of an MA, that means the Medicare Advantage plan includes Part-D Prescription coverage in addition to Medicare Part A and B.

What Medicare Advantage Plans Are NOT

  1. Medicare Advantage plans are NOT Medicare Supplements. A few of them work similarly to some Medicare Supplements in that they have relatively few co-pays, but most have quite a few differences.
  2. Medicare Advantage Plans are NOT replacements for Medicare Supplements. They are “Alternatives.”
  3. They are NOT “FREE.” Although some Medicare Supplement sales representatives have used the word “FREE,” that is not the case. Even if a Medicare Advantage plan has a $0 premium, the private insurance company is getting paid. Medicare distributes funds to the companies providing Medicare Advantage plans. These companies receive funds for each person who signs up for their Medicare plan.

Possible Advantages of Medicare Advantage Plans

Since Southern Senior Care represents dozens of Insurance companies (carriers) and hundreds of Medicare Supplement and Advantage plans, we can provide you with a clear understanding of how Medicare Advantage Plans work and how they differ from Medicare Supplements. Approximately 40% of our clients have switched to Medicare Advantage plans, so we have had ample opportunity to gather feedback from our clients. Here is a list of what most people consider advantages:

  1. Premiums for most Medicare Advantage plans are significantly lower than Medicare Supplement plans. The average monthly premium is around $40 dollars. There are some MA plans with $0 monthly premiums. That is why you will hear many people say they are free. But as we said above, Medicare takes moneys budgeted for one year of your health expenses and distributes that to your Medicare Advantage carrier.
  2. Some Medicare Advantage plans offer additional benefits that Medicare does not cover (dental cleanings, re-reimbursements for glasses, health club membership and other benefits.)
  3. Most Medicare Advantage plans include Part-D Prescription coverages

Possible Disadvantages of Medicare Advantage Plans

The following may or may not be a disadvantage to you. These are comments that we have received from our clients regarding different Medicare Advantage Plans.

  1. You may not not be able to use the doctors you want or go to the hospital you prefer. Doctors, Hospitals and Healthcare providers do not have to accept Medicare Advantage Plans. In fact, they can accept a plan today and then decide they don’t accept the plan tomorrow. It is completely up to them.
  2. Your doctor may accept a Medicare Advantage plan and refer you to a specialist who does not accept the plan.
  3. Most Medicare Advantage plans have co-pays associated with every service provided. For example you may have a $10 co-pay for your doctor, a $25 co-pay for a specialist, a $250/day co-pay when you are admitted to a hospital. Benefits of Medicare Advantage plans vary greatly. Medicare Advantage plans require more homework on your side.
  4. You can only make changes to Medicare Advantage Plans during certain times of the year. Generally, you can only change Medicare Advantage Plans and Prescription Plans during the annual enrollment period (Oct. 15 – Dec. 7).
  5. There is no guarantee you will be able to keep your Medicare Advantage plan from year to year. Medicare Advantage companies have an annual contract with Medicare. They can decide each year if they want to continue to provide a plan. If they decide to cancel the plan, you will need to find another plan in your area. This is a service Southern Senior Care provides for our clients, so it sounds worse than it is. It’s actually fairly common and is usually not a big deal.
  6. Even if a Medicare Advantage company continues to offer a plan, it may not be available in your county.
  7. There is a little more paperwork involved. With Medicare Advantage plans you will likely receive more invoices, bills, etc. For some reason Medicare Advantage plans seem to create more paperwork for policy holders, and with more paperwork comes more confusion.
  8. When you sign up for a Medicare Advantage plan, there are generally no health questions, except for ESRD (end stage renal disease), so if you want a Medicare Advantage plan and it is available in your area, you can almost always get it.

If these lists generated more questions for you, just send them to us and we’ll answer them for you. Comments and Questions Form