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How Do Medicare Advantage Plans Work?



senior studying Medicare Advantage plans.
Not all that long ago, there was only one way to go when it came to Medicare coverage.  First one would acquire Medicare coverage.  They would then supplement the coverage by purchasing a Medicare Supplement plan.  This is because a stand-alone Medicare plan contains "gaps" in coverage that could lead to significant out-of-pocket costs for certain medical occurrences.  There are a variety of supplement 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.

Medicare Advantage Plans are an "all in one" alternative to the Original 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 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.

Good to know:  Pay less for prescriptions.  Go generic, for starters.  In almost every case, generics are just as good as name brands and are much cheaper, says Catherine Tom-Revzon, a pharmacist at The Children's Hospital at Montefiore, in New York City.  Second, compare costs since prices vary significantly from store to store.  Your best bet may be a warehouse club like Costco or Sam's Club.  (You don't even need to be a member.) Another option: If your plan has a mail order pharmacy, you might be able to get 90 days' worth of prescriptions mailed to you for two co-pays.
courtesy of Parents.com
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:  When it comes to medical services, shop around for a better deals.  Patients often think that medical fees are set, but just like any other business, costs for goods and services can vary widely.  Shop the cost of exams, tests, procedures, medications, nursing facilities, and imaging centers before non-emergency events.  The price of an MRI on one side of Main Street can be $500, and $2,500 on the other.  Healthcare pricing, as a rule, is arbitrary.  Even the pharmacy you choose can be the difference in hundred of dollars annually.
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.

For more information concerning Medicare Advantage, Medicare Supplement or Medicare Prescription Drug Plans, please give us a call.


Other articles:
The Pros and Cons of Medicare Advantage Plans
5 Strategies For Reducing Medical Bills.
Finding Short-Term Health Insurance.
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