Medicare Advantage Plans: 10 Things Seniors Need to Know

Medicare Advantage Plans are also known as Medicare “Part C” and are typically either a HMO or PPO plan, and once enrolled, you now agree to get your Medicare Part A and Part B benefits through that particular plan, not directly from Medicare. These plans, which are offered by private insurance companies, have a contract with Medicare in order to allow them to provide seniors with coverage for everything from doctor visits to prescription drugs. Although they are helpful, these plans are often confusing.

With that in mind, here are the 10 things that boomers and seniors alike need to know:

1) Medicare Advantage Plans Offer Complete Part A and B Coverage

Although they are commonly known as substitutes for Original Medicare coverage (which is Medicare Part A and Part B), Medicare Advantage plans actually allow customers to have full Medicare Part A and B coverage. They simply contract with private companies to do so.

However, plans only cover 80%, but you now have a maximum out-of-pocket for the plan year… versus having just Medicare Part A and B and no cap on how much you could spend in a calendar-year. The maximum out-of-pocket number on any given advantage plan is made up of co-payments and co-insurance.

2) Providers Can Join or Leave Networks at Will

Medicare Advantage providers can join or leave a provider network any time they want. This opens Medicare Advantage plans to a higher rate of change and variability than certain other types of insurance, such as Medicare Supplement insurance, where there are NO networks at all.

3) Joining a Clinical Research Study can Help Lower Costs

For seniors with a Medicare Advantage plan, joining a clinical research study can help cover costs related to the insurance plan. Although this cost-lowering option may not be right for everybody, it can be a helpful avenue for interested seniors.

4) Medicare Advantage Plans Have an Annual Out-of-Pocket Cost Limit

As mentioned earlier, with a Medicare Advantage plan, seniors won’t ever pay more than the plan’s yearly out-of-pocket cost limit. This limit applies to a wide variety of medical services and may differ between versions of the Medicare Advantage Plan. 

5) Medicare Advantage Plans Have Caps on What They Can Charge

When it comes to medical costs, Medicare Advantage plans cannot legally charge more than Original Medicare for needed services like dialysis, nursing and chemotherapy. This helps seniors keep insurance costs down and budget for healthcare expenses.

6) Seniors Enrolled in a Medicare Advantage Plan Still Have Medicare Rights

Although Medicare Advantage plans are slightly different than Original Medicare, seniors who purchase Advantage plans still retain all of the rights and protections of Medicare.

7) Medicare Advantage Plans and Enrollment Periods

Interested seniors can only enroll in a or change their Medicare Advantage plan at certain times during the year. Most plans offer a year’s worth of coverage with the option to renew or change the plan at the end of that year.

8) You are Still Part of the Medicare Program

Although they operate slightly differently than other medical insurance plans, Advantage plans are still a part of the Medicare program.

9) With a Medicare Advantage Plan, Out-of-Network Doctors May be More Expensive

As is true with many insurance plans, out-of-network doctors, suppliers and facilities are generally more expensive than participating providers. Additionally, a Medicare Advantage plan may not cover costs with out-of-network providers.

10) Medicare Plans Are Available to Individuals With Pre-Existing Conditions

For seniors with pre-existing conditions, these plans are fantastic coverage options. The only pre-existing condition these plans will not accept is End-Stage Renal Disease.

If you’re interested in learning more about Medicare Advantage plans and whether or not these plans might be a good option for you, call Chad directly at (888) 901-4870 or visit Lifelong Insurance, LLC and leave us your contact information.