Medicare Advantage Explained

Medicare Advantage Explained from a cheerful teacher looking at the camera

Medicare Advantage Explained – You’ve seen them advertised on TV, heard about them on the radio, and probably gotten a call or two from someone who wanted to sell you a Medicare Advantage plan. About 35% of all Medicare beneficiaries are enrolled in one of these plans, and that percentage gets larger and larger each year. But what is Medicare Advantage?

Today, we’re going to talk about how Medicare Advantage works, what coverage they offer, and who is eligible to enroll. Let’s get started.

What is Medicare Advantage?

Medicare Advantage is also called Medicare Part C. It’s not a mandatory part of Medicare, but it is one way to supplement the benefits you have under Parts A and B of Original Medicare. See, Original Medicare, while offering great coverage, will leave you with quite a few out-of-pocket costs. A Medicare Advantage plan is one way to reduce your medical expenses.

Medicare Advantage plans often include extra benefits. Since there are hundreds of plans to choose from on the market, we can’t say exactly what is included in each plan. You’ll have to look at the plan’s summary of benefits to determine what’s included. However, some of the common perks are routine and restorative dental care, vision exams and eyeglasses, hearing exams and hearing aids, gym memberships, meal delivery, and gym memberships. Some plans even include transportation to and from doctor visits and a stipend for over-the-counter medications.

The best part? Many of these plans offer $0 premiums. (Now you can see why they’re becoming so popular!) Now, don’t make the mistake of thinking these plans are free. You’ll have other costs associated with them, which we’ll talk about next.

Photograph of colorful Wooden Block Letter C representing Medicare Part C plans work
The federal government actually pays private insurers to offer Part C

How do Medicare Part C plans work?

First, let’s talk about why Medicare Advantage plans have such low premiums. The federal government actually pays private insurers to offer Part C plans to Medicare beneficiaries. The reason it does this is that if you enroll in Part C, all of your benefits from Parts A and B will be rolled into your Part C plan. That means that the insurance company will now be responsible for all of your medical claims, not the Medicare program.

Premiums are also low because Medicare Advantage plans require you to pay deductibles, copays, and coinsurance costs. Exactly what you’ll pay depends on the plan, but let’s review some common costs here. For example, each time you visit the doctor, you may need to pay $20 at each appointment. Every emergency room visit might cost you $50. If you get admitted to the hospital, you’ll have a set cost per day that you stay. So, the amount you’ll end up paying will depend on how much medical attention you need.

Medicare Advantage plans put a big focus on preventive care. They want you to get regular checkups and vaccines so that you stay healthy and don’t need more expensive medical treatment. They also use provider networks to reduce their expenses. You’re probably familiar with how these works if you had an employer-sponsored health insurance plan prior to Medicare.

For example, if you get a Medicare Advantage PPO plan, you’ll have the most benefits if you see a provider who participates with that PPO insurance company. If you choose to see a non-PPO provider, you’ll pay more for the services you receive.

There are six types of Medicare Advantage plans, so be sure you understand which providers are in your plan’s service area before you enroll. If your current providers are not included, you’ll need to either choose a different plan or consider switching providers.

Who can enroll in a Medicare Advantage plan?

After you’ve enrolled in Original Medicare, you can choose to enroll in a Medicare Part C plan if one is available in your area. Rural areas tend to have fewer plan options than are present in urban cities since these plans rely on provider participation.

One type of Medicare Advantage plan, Special Needs Plans, has additional eligibility requirements based on either your Medicaid status or chronic conditions. These are referred to as C-SNPs and D-SNPs. (“C” for “chronic” and “D” for “dual-eligible.”) You’ll need to work with a licensed insurance agent to find out if you qualify for one of those plans.

If you’d like to learn more about Part C, our Medicare advisors are available to answer all of your questions. We can teach you the ins and outs of these plans and also talk about your other options, like Medicare supplement insurance. Once you decide which plan is best for you, we’ll help you through the enrollment processes and get you moving on your Medicare journey. Contact our office today and schedule a complimentary consultation.

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