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Medicare Advantage

You get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan

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Some Medicare Advantage plans also have additional benefits.

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services.

at certain times during the year. In most cases, you’re enrolled in a plan for a year.

In general, Medicare Advantage costs less upfront and potentially more overall if you need significant medical care.

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Medicare Advantage plans have several differences in comparison to Medicare supplements. I generally suggest my clients think of Medicare Advantage plans as alternatives to Original Medicare coverage. Original Medicare contains Parts A and B. Medicare Advantage plans are often called Part C or MA plans. Medicare Advantage plans must cover all the services that Original Medicare covers.

In Original Medicare, providers initially bill Medicare and later bill a supplement company. After both Medicare and the private supplement company have paid their portions, individuals may be responsible for the left-over portion. With Medicare Advantage plans, the private insurance company is billed. For example, if an individual has a Part C (MA plan) with company XYZ and visits his primary doctor or gets services at a hospital, the bill will be sent to company XYZ-not Medicare. As a result, the individual may be responsible for a copay or a deductible.

Sometimes, Medicare Advantage plans are called “all-in-one” plans because the plans incorporate other coverages beyond medical. Many Part C plans include prescription drug coverage. These plans are often referred to as MAPD (Medicare Advantage Prescription Drug) plans. Some plans include coverage for dental, vision, hearing, wellness programs, and/or other ancillary benefits. Medicare Advantage plans vary greatly and need to be examined very closely on an individual basis.

Some Medicare Advantage plans have a premium. These premiums vary widely. However, there are plans that have a $0 monthly premium. That being said, in order to enroll in a Medicare Advantage plan, individuals are still required to pay the Part B premium. Plan access varies greatly by county. For example, a $0 monthly premium plan may be available to one county but may not be available in another county.

There are several types of Medicare Advantage (Part C) plans available. Click here for a description of each type. Here is a list:

PPO Preferred Provider Organization
HMO Health Maintenance Organization
PFFS Private Fee-for-Service
HMOPOS Health Maintenance Organization Point of Service
MSA Medical Savings Account
SNP Special Needs Plans

The enrollment in Medicare Advantage (Part C) plans has been steadily increasing over the last fifteen years. Below is a graph from the Kaiser Family Foundation which illustrates these increases.

Medicare Advantage (Part C) plans come in a wide variety of packages, and there are different plans available county to county.  If you are interested in exploring this option, please fill out the form to be contacted.

Justin Eggenberger

Medicare Advisor

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by insurance companies and they are the most complicated, but they are less expensive.

by state, by deductible and copay amounts. With these plans the Medicare people turn over your Part A coverages & Part B coverages and premium to the insurance company.

With these plans you are charged many little fees and copays for each procedure, so you are somewhat only paying for what you use. This helps keep the cost down.

Medicare-Advantage-Colorful

34%

22 million people

Are enrolled in Medicare Advantage plans

29%

Of new Medicare beneficiaries

Are enrolled in Medicare Advantage plans during their first year

62%

Of the 22 million

Medicare Advantage enrollees are in in HMOs, with the rest in local or regional PPOs

Types of Medicare Advantage plans
There are different types of Medicare Advantage plans to choose from, including:

  • Health Maintenance Organization (HMO). HMO plans utilize in-network doctors and require referrals for specialists.
  • Preferred Provider Organization (PPO). PPO plans charge different rates based on in-network or out-of-network services.
  • Private Fee-for-Service (PFFS). PFFS plans are special payment plans that offer provider flexibility.
  • Special Needs Plans (SNPs). SNPs help with long-term medical costs for chronic conditions.
  • Medical Savings Account (MSA). MSA plans are medical savings accounts paired with high deductible health plans.

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Medicare Advantage (MA) plans are bundled benefits and function similarly to an HMO or PPO. With original Medicare hospital insurance (Part A) and medical insurance (Part B) are included in the benefit.

Justin Eggenberger

Justin Eggenberger

Licensed Insurance Agent
815-258-3070