Medicare Advantage Plans - MA Plans - MAPD

Southern Senior Care

770-910-7824 (office)

800-315-6898 (tollfree)

2081 Furlong Run

Lawrenceville, GA 30043

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Medicare Advantage: Table of Contents

Overview

What Medicare Advantage Plans Are

What Medicare Advantage Plans Are Not

Possible Advantages of Medicare Advantage Plans

Possible Disadvantages of Medicare Advantages Plans

Medicare Advantage Overview

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, but most do not.
2.	Medicare Advantage Plans are NOT replacements for Medicare Supplements. They are "Alternatives."
3.	They are NOT "FREE." Although many Medicare Supplement sales representatives will use the word "FREE," that is not the case. Currently, Medicare is paying the MA companies an amount of money (most believe a rather large amount of money) to cover the healthcare costs of MA clients.

Advantages of Medicare Advantage Plans

Since we represent dozens of companies and literally hundreds of Medicare Supplement and Advantage plans, we can give you what we believe is a very objective view of the relatively new Medicare Advantage Plans. Approximately 25% of our clients have switched to these 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 MA plans are lower than Medicare Supplement Premiums. The average montly premium is around $45-$55 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 is currently giving the MA companies all of your Medicare Part-B premium, currently $96.50 for most people and addiitonal money each month.
2.	Some MA plans offer addiitonal benefits that Medicare does not cover (dental cleanings, re-embursements for glasses, health club membership and other benefits.)
3.	Some MA 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 see 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 want to 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, only to find that the specialist does not accept the plan. This is the possible price you pay for the very low premiums.
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. MA plans are one product where you definitely need to read the small print.
4.	You can only make changes to Medicare Advantage Plans during certain times of the year. Generally during the annual enrolment period (Nov. 15 - Dec. 31) and the open enrollment period (Jan. 1 - Mar. 31) you can add, change or drop a plan.
5.	You are not guaranteed to be able to keep your MA plan. 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.
6.	Even if a Medicare Advantage company continues to have a plan, they may not continue to offer it in your county. It is very common for plans to come and go in different counties.
7.	There is more paperwork involved. With Medicare Advantage plans you will almost certainly receive more invoices, bills, eobs, etc. For some reason Medicare Advantage plans seem to create more paperwork for policy holders, and with more paperwork comes more confusion. Again, this is the price for lower premiums.
8.	When you change from a Medicare Supplement plan to a Mediare Advantage plan, there are generally no health questions, except for ESRD (end stage renal disease). However, after your twelve month "trial period" has ended, if you want to switch back to a Medicare Supplement, you will have to answer some health questions. Click Here to see a sample list of questions. If you cannot answer "No" to all of the quesitons you may not be able to get a Medicare Supplement policy.