Medicare Advantage Plans (also known as Part C) have been around for years and offer many attractive features to people on Medicare. These plans are offered by private insurance companies that have a contract with CMS (the organization in charge of Medicare). These plans pay the Medicare benefits for their members instead of being paid directly by the Medicare program. In return, the insurance companies receive money from the government for each enrollee in addition to any premium they charge to the member.
Medicare Advantage plans come in many varieties with different benefits, but generally they were designed to save money on the cost of healthcare for both their members and the Federal Medicare program. The cost savings to the plan and the enrollee come from the agreements the insurance companies have with their network of providers and facilities.
Another cost-saving benefit Medicare Advantage plans offer is their cap on annual out-of-pocket medical expenses. Where Original Medicare has no limit in place, all Medicare Advantage plans agree to pay for 100% of your covered medical expenses beyond a set dollar amount. This amount can vary by plan, so when we meet we can discuss which option would work best for you.
With a Medicare Advantage plan your share of the cost for your healthcare will be met through co-payments and co-insurance. The remainder of the costs get picked up by the plan subject to that plan's benefits.
People considering Medicare Advantage Plans should take note of the extra benefits that often come with these plans. Many include the Part D prescription drug coverage normally offered through a separate plan and they often cover services for other types of care not covered by original Medicare.
CMS and Medicare no longer allows agents to describe these benefits on their website, so I encourage you contact me at 309-696-7933 or fill out the form at the bottom of this page to learn more about what types of benefits you may be eligible for with these plans.
While not all plans offer the same benefits package, these types of features are not offered by Original Medicare and provide a good reason to give Medicare Advantage plans a closer look.
Medicare Advantage Plans are frequently labeled as an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Both types have a provider and facilities network through which their members obtain healthcare services. The difference between an HMO and a PPO can be found in the network size, cost-sharing for the member, and the ability to see out-of-network providers. HMOs are the most restrictive but tend to offer a lower cost-sharing for their members while PPOs are less restrictive and allow members to see out-of-network providers for an additional cost.
It is very important when selecting a Medicare Advantage plan that we verify that your healthcare providers are in-network for the plans you are considering. I have tools that I can use to make sure your plan works with the doctors you see so you don't find yourself without coverage from the providers and facilities you trust with your care.
While Original Medicare does not cover prescription drugs, the Part D program allows Medicare recipients to get their medications at a lower cost. Many Medicare Advantage plans include a Part D benefit with the same types of coverage offered by the standalone Part D plans.
Medicare Plans with a Part D benefit are structured in the same way as standalone Part D plans, The convenience with these plans is that your prescription coverage is included with your medical benefits so you won't have to purchase a separate policy for your drug coverage.
If you will have another type of prescription drug coverage such as VA benefits or an employer-sponsored plan, we can look into Medicare Advantage plans that don't include prescription drug coverage too. Be aware that in most cases, if you choose a plan without prescription drug coverage you won't be able to choose a separate Part D plan to go along with it.
Much like verifying the network status of your healthcare providers, it is equally important that we verify that the prescriptions you are currently taking are covered by any Medicare Advantage plans you are considering. My tools allow me to both verify that your prescriptions are covered and provide you a cost estimate for those medications at your preferred pharmacy.
Both types of plans limit their enrollment to the geographic area they service, and potential enrollees should note if their coverage will travel with them if they spend significant amounts of time away from their primary residence. If a member moves out of the service area for their plan, they are given a special enrollment period to choose a new plan that is offered in their new home’s region.
You will find the largest selection of in-network healthcare providers closer to your home, but if you are travelling and experience an emergency, these plans offer coverage regardless of where you are in the United States. Some plans now offer a nationwide network of providers for you to choose from that expands your choices for where and from whom you receive your care.
This regional focus also means that plans may be available in some counties and not in others. I have tools that allow me determine which plans are available in your county and help you figure out which will be the best fit for your needs.
Provider networks, drug formularies, co-pays and co-insurance can make Medicare Advantage plans seem more complicated than other types of insurance. In reality, they are similar to other types of coverage you've enjoyed in the past. We just need to make sure to find the one that will best meet your needs. It all starts with a conversation.
If you are interested in learning more about Medicare Advantage Plans and if they could be right for you, please contact me with your questions and we can review the options available in your area.
I can meet in-person, via the phone, or even via video-conference with my laptop and your internet-connected computer, smartphone or tablet. Simply fill out the form below and I'll be in touch shortly to schedule a time to review your needs, answer your questions, and hopefully make this all seem easier to understand. Or if you prefer, you can call me directly at 309-696-7933.