Medicare Advantage

What is a Medicare Advantage Plan?

Medicare Advantage (MA) Plans are all-in-one health plans offered by private insurers. It is also known as Part C of Medicare.

Medicare Advantage plans actually do replace Original Medicare (Part A Hospital and Part B Medical). This means that Medicare is not liable to pay any claims for you, the private insurance company that you choose will take over.

Characteristics of a Medicare Advantage plans

Unlike Original Medicare, Medicare Advantage plans use a network of doctors and facilities. The two most common types are HMO plans and PPO plans. HMO stands for Health Maintenance Organization. This means that you are only allowed to go to doctors within the network of your plan. There is no out-of-network coverage. Usually, HMO plans have lower costs associated because you are staying in network. A PPO plan stands for Preferred Provider Organization. In this plan there is still a network. You can still go to all in-network doctors and receive the preferred cost sharing, but you also have the option of going to out of network doctors at a higher cost.

Who might be interested in a Medicare Advantage Plan?

Medicare Advantage plans generally have low or no premiums. To many beneficiaries on fixed incomes, this can be a very attractive quality. Although, Medicare Advantage Plans typically have copayments. That means that the private insurance company only pays part of the claim and you pay a copay when you go to the doctor. Copay's vary by plan and location.

Some beneficiaries are also attracted to the extra benefits associated with some plans. MA plans can offer benefits not covered by Original Medicare. Some examples are:

Dental allowances
Vision coverage
Hearing exams / hearing aids
Over-the-Counter drug allowances

Of course, all plans vary in benefits. Some benefits may also change from year to year. But in general these are some of the reasons why people really love MA.

What are the disadvantages of Medicare Advantage (Part C)?

Because you are using a network offered by a private insurer, your options will be a little more limited than Original Medicare (Part A & B).

This is true especially in rural communities where less providers are available. This isn't always the case, but sometimes we do see that some facilities with refuse to accept these plans. Even PPO Plans. It can also make receiving care while traveling a little more complicated.

Prior-Authorizations. All MA plans have some form of prior authorizations. For example, a client with a Medicare Advantage plans wants to get their hip replaced because it is giving them some issues walking. The doctor may have to submit a Prior-Authorization because it is quite a big procedure, asking the insurance company if it is ok to do the procedure. The company can approve of it, or they can also ask for more information about the procedure and the clients condition. After the company receives more info, they can approve the procedure, or they also have the right to suggest a different form of therapy first.

In this way, some clients may receive a delay in care. This depends on the specific details of the operation. Prior-Authorization is not required on every form of service.

Some clients never have any issues. Some do, some don't. Either way its very important to know about how your specific plan works. That is also why we are here to help.

Do the Pro's outweigh the Con's? What should I do?

We want to make sure our clients have all the information necessary to make an informed decision. Ultimately, this is your personal healthcare plan and not ours. So we will do all that is necessary to make sure you make the right decision.

For some clients, the Pro's absolutely out-weigh the Con's. For others, the Medicare Supplement makes more sense and offers more freedom

To see which product might be right for you, give us a call at (402) 890-6868 or to request help, click the button below.

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