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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:  Starting around their first birthday, kids should get twice-yearly checkups from the dentist, says Keith Morley, DMD, president of the American Academy of Pediatric Dentistry.  Preventive care, nips problems in the bud before they become more costly.  You should also talk to your dentist about getting sealants for your child's molars.  (Sealants are a liquid plastic material applied to your child's back teeth to prevent them from decaying.) Many insurance companies cover the cost, but even if they don't, get them anyway: They'll probably save you money in the long run.
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:  You shouldn't promptly pay medical bills.  Yes, you read that right.  The reason is, healthcare providers tend to send bills well before the insurance company has decided what part of the claim they are obligated to pay.  The average person sees a bill and thinks they are obligated to pay it.  This couldn't be further from the truth.  Health care companies routinely shoots out bills to everyone one involved - regardless of who is actually responsible for paying it.  You need to know what the insurer is going to pay before you do anything.  Our advice? Don't pay a dime until you get an EOB (Explanation of Benefits) from your insurer that explains your claim and how much they are paying.
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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