What is Medicare Advantage?
Medicare Part C (Medicare Advantage) has quickly become one of the most popular choices for Medicare Beneficiaries. They typically offer more benefits than Original Medicare or Medigap, and their premiums can be as low as $0. That makes Medicare Advantage Plans an affordable option for pretty much everyone.
If that all sounds like something you would be interested in let us tell you a little more about Medicare Advantage.
The Basics
Medicare Part C is also known as Medicare Advantage Plans (MAs). MAs are Medicare-approved and regulated private insurance plans. MAs combine Parts A, B, and often Part D into one. That means only have one plan, one card, and one policy number.
Benefits typically go beyond Original Medicare and will commonly include things like dental, vision, hearing, fitness programs and gym memberships, transportation coverage to and from health care services, and over-the-counter benefits.
When can I sign up?
You can purchase an MA a few different times.
When you first sign up for Medicare (Initial Enrollment Period)
During the Annual Enrollment Period (October 15 - December 7)
During a qualifying life event, called a Special Enrollment Period (SEP).
How do I sign up?
To sign up for an MA, you go shopping for one. Plans are purchased through brokers like us or directly with the government at Medicare.gov.
What does it cost?
MAs have monthly premiums in addition to your Part B premium, but many offer premiums as low as $0. Other costs associated with MAs are copays, coinsurance, and deductibles.
MAs have maximum out-of-pocket limits (MOOP) for healthcare services. In 2023, Medicare is allowing Medicare Advantage insurance companies to place MOOPs at a maximum of $8,300.
Part D.
You do not need a stand-alone drug plan if your MA offers prescription drug coverage, and luckily, most MAs include prescription drug coverage (Part D). The prescription drug coverages included in an MA function like any other Part D Drug Plan. It will have separate copays, coinsurance, and deductibles.
Networks.
MAs usually have networks. The two most common networks are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Networks are health service providers in a particular area that have agreed to partner with a Plan. If your plan is an HMO you will have to choose a Primary care Physician and need a referral to see a specialist. Finally, if you go outside the HMO network, you will likely have no coverage.
While HMO plans can seem restrictive, many networks are now regional or even national, so staying in the network is not the concern it once was.
PPOs have in-network coverage similar to HMOs but also provide coverage outside the network. However, if you go outside the network, expect to pay higher out-of-pocket costs, so best to stay in the network if possible.
Some other Key points.
Plans require no medical underwriting. So, pre-existing conditions and health needs are not typically a concern or affect pricing.
Remember to compare your expiring MA to the renewal to avoid unintended coverage consequences since Plans can change.
MAs shine by combining all the Parts of Medicare into one plan. They often go beyond that by offering more benefits than Original Medicare, and they do so with low monthly premiums.
