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How Do Medicare Advantage Plans Work in Massachusetts?



Senior considering options
Until recently, there was only one way to go when it came to Medicare coverage.  First you would acquire Medicare coverage.  You would then supplement your coverage by purchasing a Medicare Supplement plan.  A stand-alone Medicare plan contains "gaps" in coverage that can lead to significant out-of-pocket costs for several possible medical circumstances.  There are a variety of Medicare supplement health plan options that provide different levels of supplement protection.  The various plan types are designated by letters of the alphabet (A-N).  Generally, the more comprehensive the coverage, the higher the cost of the supplement plan.

Good to know:  Ask for a discount.  You can potentially reduce the cost of your medical bills by asking for a discount upfront.  It may seem unconventional, but many hospitals and practitioners offer certain discounts for which you may be eligible.  For example, some hospitals are part of networks that will reduce your medical bills by a certain percentage if you pay over the phone.  More often than not, these discounts are only available to consumers who ask for them.  Depending on your economic status or the price of your procedure, some medical facilities offer additional discounts that can be paired with your medical insurance to substantially reduce the cost of your procedure.  For example, it's not uncommon for hospitals to offer discounts of up to thirty percent for qualifying customers.

Even if you don't find a discount related to your particular situation, your doctor or hospital may provide you with valuable information about discounts you can use in the future.

In Massachusetts, Medicare Advantage Plans are an "all in one" alternative to the Original Medicare / Medicare Supplement plan arrangement.  These plans are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These "all in one" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

Medicare Advantage Plans cover all services covered by original Medicare.  In addition, Advantage plans are required to offer at least the same level of coverage as the Original Medicare Part A and Part B coverage.  In almost every case, Advantage plans feature several attractive additional benefits that are not covered by original Medicare.  Dependent upon which Massachusetts advantage plan you choose, these benefits may include coverage for vision care, hearing aids, dental care, prescription drug coverage, transportation to and from medical facilities, and even fitness center membership.  The end result is a very comprehensive medical insurance plan.

Improvements for 2020

What's new?  Beginning in 2020, Medicare Advantage plans will have the option of covering several items that you would not expect to be covered by any health insurance plan.  Such as for example, a person with diabetes could receive transportation to a doctor's appointment, to a diabetes education program, or to a meeting with a nutritionist.  Some Medicare Advantage plans will even pay for cooking classes as part of improving someone's eating habits!  For someone with heart disease, a Medicare Advantage plan could provide heart-healthy produce or other foods that promote heart health.  For asthma, the plan could cover air cleaners or even pay to shampoo a subscriber's carpet to remove the irritants that often trigger asthma attacks.  2020 will see a host of new, attractive, Medicare Advantage Plan Benefits.

If you enroll in a Medicare Advantage plan, you continue to pay your Medicare Part B premium.  The private insurer determines what the Medicare Advantage plan premium will be.  This premium amount will vary from one plan style to another.

Medicare Advantage plans tend to be significantly less expensive than Medicare Supplement coverage.  Some Medicare Advantage plans may have premiums as low as $0.

Copay costs may also be less with a Medicare Advantage plan.  For, example, if you visit a primary care physician under a Medicare Advantage plan, you may pay a copayment of $10.  However, if you visit a primary care physician under Original Medicare, you may have a coinsurance of 20%, which could be significantly more than $10.

A Medicare Advantage plan will limit your maximum out-of-pocket expense.  Once you have spent that maximum, you pay nothing for covered medical services for the remainder of the year.

Good to know:  Ask questions.  If you don't understand the details of the plan offered, contact the insurance company or give us a call.  While there are a variety of online tools and resources that can help, the best thing to do is simply pick up the phone and talk to an insurance professional.  You need to clearly understand what you're buying.

Medicare Advantage Rules and Guidelines

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans.  In turn, these companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different Out-of-pocket costs.  They can also have different rules for how you get services – for example:

  • Whether you need a referral to see a specialist.
  • What shared medical costs you are responsible for.


Which Medicare Avantage Plan Carriers Are Available in Massachusetts?

Following is a list of some of the insurance companies that offer Medicare Advantage plans in Massachusetts:

  • Tufts Health Plan - Massachusetts. (Several plan variations)
  • Aetna - Massachusetts. (Several plan variations)
  • Medicare HMO Blue - Massachusetts. (Several plan variations)
  • Harvard Pilgrim Health Care, Inc. (Several plan variations)
  • UnitedHealthcare. (Several plan variations)
  • AARP. (Several plan variations)

Interesting Fact:  The per capita price of healthcare per year is higher in the United States than in any other nation in the world.  In the U.S., healthcare spending accounts for 17.9 percent of the Gross Domestic Product (GDP), or the total value of goods and services produced by the entire nation for the entire year, according to the Centers for Medicare & Medicaid Services.
For more information concerning Medicare Advantage, Medicare Supplement or Medicare Prescription Drug Plans, please give us a call.


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