Medicare Advantage Plans

Medicare Part C, more commonly known as Medicare Advantage plans, are a type of health plan offered through private companies that contract with Medicare to provide you with your Part A (Hospital) and Part B (Medical) benefits. Medicare Advantage plans work much like insurance during our working years with networks for doctors and hospitals, deductibles, and co-pays. In addition to their full Medicare benefits, Medicare Advantage plans may also include vision, dental, drug coverage, and more.

10 Key Factors About Medicare Advantage Plans

#1 | You Are Still Part of Medicare

Although Medicare Advantage plans are provided through a private insurance company, you are still a part of the Medicare program. Hence, you are still entitled to have the same Medicare rights and protections as you would with Original Medicare, including the right to appeal a coverage decision.

#2 | Beware of Network Limitations

Many Advantage plans have networks; meaning there is a list of providers for doctors & hospitals that are accepted under that specific plan. However, you are able to use doctors outside of your plans network, just be cautious. of the additional cost associated. Additionally, sometimes the costs you pay to see providers out-of-network will not apply towards your out-of-pocket maximum. So it’s important to check that your current doctors and hospitals are in network for the plan you are selecting and always request for a referral from your doctor if you want to see a specialist.

#3 | Pre-Existing Conditions Are Covered

Not only can you enroll in a Medicare Advantage plan if you have any pre-existing conditions, you can also switch Medicare Advantage plans without answering any health questions. So you can’t be denied if you’ve had a heart attack or stroke, or any other illness of that matter if you are looking to switch to a different Advantage plan, they can’t deny you. The only exception is end-stage renal disease (ESRD).

#4 | Low Monthly Premiums

Medicare Advantage Plans were created by congress as a more affordable option for Medicare beneficiaries, compared to Medicare Supplement Plans. Since Medicare has contracts with private insurance companies to provide your Part A & B benefits on behalf of Medicare, monthly premiums are fairly low for Advantage plans. However, in exchange for your low monthly premiums, you will have to pay more upfront for your services as you use them; in the form of copays and coinsurance. These fees can add-up over time if you’re visiting the doctor frequently. Hence, how often you visit your doctor can play a major role when trying to decipher which plan is best for you.

#5 | Out-Of-Pocket Maximum "Safety Net"

Unlike Original Medicare alone, all Medicare Advantage plans have out-of-pocket maximum that reset annually. Meaning, there is a cap on how much you will end up paying out-of-pocket for your covered medical expenses. We like to think of this as a “safety net” to protect you from being responsible for any hefty unexpected medical bills.

#6 | Included Additional Benefits

With Original Medicare (Parts A & B), the coverage can be very limited. Fortunately, in addition to the standard Medicare Advantage plan benefits, most plans offer an array of additional coverage benefits. Such as drug coverage, vision, dental, and hearing insurance, and even monthly gym memberships!

#7 | Don't Be Fooled by "$0 Premium Advantage Plans" Commonly Advertised

It’s no secret that Medicare Advantage Plans are commonly advertised as “$0 monthly premiums” or have the word “FREE!” attached to it… However, your coverage certainly isn’t free… It’s just structured differently. Although there are zero to low monthly premiums, you will be required to pay any deductibles, copays, and coinsurance as you use your coverage. Additionally, since you’re still in the Medicare program, you will still need to pay for your Part B premium monthly payments. So don’t let those TV advertisements claiming “$0 monthly premiums!” or “FREE Advantage Plan!” commercials deceive you.

#8 | Switching Advantage Plans is Easy

If you’re enrolled in an Advantage plan but want to switch to a different Advantage plan for whatever reason, you can do so during the Medicare Open Enrollment Period (OEP). The OEP is October 15 to December 7 every year. Unlike Supplement plans, there are no health questions and you don’t have to go under any medical underwriting to get approved for your new plan. This can be beneficial if you had detrimental incident affect your health during the past year, like a heart attack or stroke. Making it easy to switch plans can be a deciding factor for some people so it’s important to keep this in mind. Additionally, it’s important to note the Open Enrollment Period is different that your Initial Enrollment Period (IEP), when first joining Medicare. If you happen to miss your IEP, you will have to wait until the following OEP to enroll in Medicare. So it’s important you don’t miss it since there can be some hefty penalties that come along with no coverage!

#9 | Eligibility Requirements & Enrollment Process

To be eligible to enroll in a Medicare Advantage plan, you must have Medicare Part A & Part B, you must permanently live in the plans service area that you’d like to enroll in, and you cannot have end-stage renal disease (ESRD) in most cases. You’ll want to apply for a Medicare Advantage plan during your “Initial Enrollment Period” (IEP). Which is a 7-month period that starts 3 months before you turn 65, your birth month, and 3 months after you turn 65. This is when you will want to apply for a Medicare Advantage Plan.

#10 | Drug Coverage Is Often Included

Most Advantage Plans include Part D (Prescription Drug Coverage), so there is no need to buy a separate drug plan. Some people prefer having their drug coverage built into one plan, simply because of the convenience factor. While it can be the deferring factor choosing an Advantage plan. Reason being, if their medications are not included under their Advantage plan, their stuck paying higher out-of-pocket costs for their medications. And unfortunately, if you do choose an Advantage Plan that includes drug coverage, you cannot opt out to get a standalone Part D plan. However, as previously mentioned, there are some Advantage plans that don’t include drug coverage, in which case you can get a standalone Part D plan that covers your medications. We recommend weighing these factors when it comes to choosing a Supplement or Advantage plan.

Medicare Advantage Plan Finder Tool

Watch this video to learn how you can easily shop for a Medicare Advantage Plan online using this simple tool. We will give you an in-depth, unbiased, explanation on the ins and outs of this tool and how it can benefit you when selecting a Medicare plan.

With this free quoting tool, you can easily compare your coverage options, shop for drug plans, keep track of your prescription medications, and so much more! Watch this video to learn more about this helpful tool.

Medicare Hero
Super Tip!

Limitations, copayments and restrictions my apply. Each plans benefits, formulary, pharmacy network, provider network, premiums and copayments may change on January 1 of each year. Members need to be diligent about reviewing the plan materials sent to them each year in September to see what is changing.

Medicare Advantage Explained...

With a Medicare Advantage plan you will be responsible for co-payments and other out-of-pocket expenses when you use your coverage. Each company sets its own cost-sharing for each covered service. As an example, you might pay a copay for a primary care doctor visit, a higher copay for a specialist, and a percentage of the cost of services such as x-rays or lab tests. When you use Medicare Advantage coverage in the hospital you may pay either a fixed amount per day or a flat amount for the whole stay.

All Medicare Advantage plans must also include an annual maximum cap on your out-of-pocket medical costs. Think of this maximum out of pocket limit as a safety net. If your out of pocket medical expenses add up to a certain amount in one year, your plan will step in and pay the rest of the cost for the remainder of the calendar year. It is important to note that Part D prescription drug costs care calculated separately and are not included in this maximum out of pocket number.

Medicare Advantage Plans may also include extra benefits not provided by Original Medicare such as vision benefits, limited dental coverage, or gym memberships. It is important to remember the insurance company has the right to change these benefits each year. Medicare Advantage plans also typically include Part D drug coverage.