Medicare Advantage Plans are a Medicare health plan offered by private Insurance companies that contract with Medicare to provide all your Part A and Part B benefits. Your Medicare services aren’t paid for by Original Medicare but by the private insurance company. Medicare Advantage Plans have to be as good or better than original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage and extras like dental, vision, gym membership.
People like Medicare Advantage Plans for the cost savings they can provide. Some plans can be as low as a $0 monthly premium which includes prescription coverage. The Medicare Advantage plan is a pay as you go plan with co-pays and co-insurance payments depending on what you have done. One safe guard they have over Medicare is that they have a maximum out of pocket for the year. 92% of people on Medicare Advantage Plans don't reach their out of pocket maximum. Maximum out of pocket can range from $3,000 to $6,840.60 for 2020 Cuyahoga county plans.
All plans have their own co-pays and HMO networks so before signing up for one a careful analysis of the following is needed.
1. Is your doctor and hospital in the HMO network? Having a plan with a PPO network will help if your doctor is out of network but you will pay more in co-insurance.
2. How do your prescriptions come up coverage and cost wise? This is not important if you don't take any prescriptions or costly prescriptions.
3. Does the plan have what you want when it comes to extras like dental, vision or something important to you like specialist co-pays or no referrals needed?
This is where an agent can help you big time. As independent agents we have all the major companies and know the plans. We can help to see if there is a benefit of one plan over the other for you. The plans change every year so again having the agent resource is valuable when it comes to Medicare Advantage plans.
Rookie FACTS: Most Medicare Advantage Plans are similar in co-pays from the different insurance companies. The biggest savings factor when comparing Medicare Advantage Plans is prescriptions. That is the first thing as agents we will look at after doctors and hospitals to find the best plan for our clients.
When you go to a hospital or doctor all you will need is your Medicare Advantage card, even for prescriptions. Even though you will not use your Medicare card, one of the requirements to get a Medicare Advantage plan is you must have Medicare Part A & B and to continue to pay for Part B premium.
How does Medicare Part C
(Medicare Advantage) Work?
You can sign up for a Medicare Advantage plan during your open enrollment period when you turn 65 or get Medicare Part B for the first time. The other time to sign up is during the Annual Election Period called AEP, between October 15th and December 7th each year. The plan will become effective January 1st of the next year. You will have to stay on the plan for at least one year but there are options like during the General Enrollment Period, (January 1st - March 31st) which allows you to opt out of Medicare Advantage plan go back to Medicare.
There is no underwriting to go through like with a Medicare Supplement plan. The only health question asked is do you have end stage renal disease (kidney failure).
More populated cities and counties with larger hospitals have a better opportunity to offer Medicare Advantage plans. You have to live in the county that the plans are offered in. Most plans have a network of HMO, some plans depending on where offered can be also PPO (can go out of network).
We always show our clients all their options (Medicare Advantage Plans vs Medicare Supplement with stand-alone RX Plan) when they turn 65 and receive Medicare.
The number one question we receive is what it better a Medicare Supplement or Medicare Advantage Plan.
Truth is half of of our clients are on Medicare Supplement Plans and half our on Medicare Advantage. Some have been on both. There is no right answer it really comes down to the client and what gives them peace of mind.
We have a chart that helps show the differences between both a Medicare Advantage Plan and Medicare Supplement when it comes to premium, network etc,..
Need help finding the right Medicare Advantage Plan or to find out which RX plan helps you save the most for your prescriptions.
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