Medicare Advantage Plans

About Medicare Advantage Plans

Medicare Advantage Plans are an alternative to Original Medicare. Private carriers take over for the Government for managing your Part A and Part B coverage, and the carriers share the expenses with the policyholder for the costs that Part A and Part B do not cover.

Advantage Plans do not participate in the “Original Medicare network”, but rather each have their own network of providers that participate.

Advantage Plans can have as low as a zero dollar monthly premium, typically include medication coverage, and often include gym memberships, routine dental, vision, and hearing coverage.

Multiple factors need to be taken into consideration in order to identify the best Medicare Advantage Plan for an individual. In addition to minimizing costs, it is important to ensure that the Medicare Advantage Plan will provide appropriate coverage, by taking the following into consideration:

Participating (in-network) Providers- Hospitals, Primary Care Physicians, Dentists, Specialists such as Cardiologist, Nephrologist, Ophthalmologist, Endocrinologist, Gynecologist, Dermatologist, Gastroenterologist, Urologist, Neurologist, Rheumatologist, Orthopedist, Podiatrist, Otolaryngologist, Allergist, and Pulmonologist to name a few.

Covered Medications- Ensure that the Medicare Advantage Plan covers your Medications and that pharmacies/mail-order options are acceptable to the policyholder.

Considerations of Medicare Advantage Plans

Pros of Medicare Advantage Plans

Zero dollar premium, so if you are not using insurance, insurance will not cost anything
Underwriting is not required to be accepted into an Advantage Plan

Cons of Medicare Advantage Plans

Not a part of Original Medicare. Providers need to be in-network with carrier and plan
Every year, more Providers are dropping out of participating in Medicare Advantage Plans
Can be expensive when policyholder does need care (shared costs)
Variable expenses each year for healthcare (not predictable)
Can only change Advantage Plan during two designated times of the year (1/1 – 3/31 & 10/15 – 12/7)
Medicare Advantage Plans can change every year; if you have found a plan that works for you, there is not a guarantee that that plan will be offered the following year

How We Can Help

Senior Advisors can help you ensure that you have a solid understanding of the differences between Original Medicare and Medicare Advantage Plans. If you determine that you prefer the Medicare Advantage Path, we can help identify the best plan for you. Identifying the best plan for you needs to be assessed each year, as Medicare Advantage Plans can change each year, and so can participating providers (Doctors and Hospitals).

KEY TAKEAWAYS

Medicare Advantage Plans replace Original Medicare. This means that you need to find doctors and hospitals that participate in your plan’s network.
Preferred hospitals, primary care physicians, dentists, specialists, and medications need to be evaluated to identify the best Medicare Advantage Plan.
Medicare Advantage Plans can change every year; if you have found a plan that works for you, there is not a guarantee that that plan will be offered the following year.

ADDITIONAL RESOURCES