How Do Medicare Advantage Plans Work?

By Edward Dominguez posted 06-28-2020 17:11


Medicare Advantage Plans offer a private insurance alternative for people enrolled in Medicare, a government health care program for retirees and the elderly. Sometimes referred to as Medicare Part C, these plans furnish Part A, Part B, and (in many cases) Part D options. However, HMOs or PPOs typically operate Medicare Advantage Plans.

Four Different Available Medicare Plans

Qualified seniors may enroll in low-cost Medicare programs. They select Part A (covering mainly skilled nursing care), Part B (covering mainly medical insurance for diagnostic tests and outpatient services), Part C (private Medicare health plans), and Part D (covering prescription drugs). First available in 1966, the Medicare program originally encompassed only Part A and Part B. It expanded over the years. Today, seniors may enroll in Part C to obtain private insurance providing the same services as traditional Parts A, B, and D plans as an option.

For example, in addition to standard Medicare coverage, some Medicare Advantage Plans also offer care that includes vision, hearing, and dental services. Seniors who select Medicare Part C plans may pay variable out-of-pocket costs. Typically, they also enjoy a different selection of treating providers (a choice more closely in keeping with conventional private insurance). These plans establish an annual limit on an insured's total out-of-pocket costs (unlike traditional Medicare).

Specific Medicare Advantage plans sometimes terminate for a variety of reasons. In these situations, the seniors who have enrolled in a terminated plan need to make a choice. They may either switch to another, different, Part C Medicare Advantage plan or opt for traditional Medicare coverage.

Navigating Through Complex Rules

Unfortunately, today Medicare as a topic involves considerable complexity. This situation proves especially true with respect to Medicare Advantage, since different Medicare Advantage programs in different states often offer quite different coverage services. Seniors may find it helpful to consult with a free online service answering questions about Medicare coverage. The website responds to detailed questions about Medicare and Medicare Advantage planning.

To read a quick synopsis of the Medicare Advantage plans available within a specific geographic area during the next year, consider visiting a government website dedicated to Medicare issues. This site furnishes an online copy of the informative Medicare & You handbook. Medicare mails a hard copy of this booklet to everyone enrolled in the Medicare program towards the end of summer.

Evaluate Medicare Advantage Plans in Detail

Since significant coverage and provider differences occur in specific Medicare Advantage plans, it generally makes sense to read each policy's terms and conditions with great care. Compare the plans available to customers within your community before making an enrollment decision. One plan may require the use of a particular provider network, while another may dictate the use of a completely different set of medical facilities. Additionally, distinct differences sometimes affect the payment of premiums during the year (especially if the plan includes ancillary vision, dental or optometry services).

In general, consumers who enroll in Medicare Advantage need to ensure they match their unique health care needs with the provider offering the best value (for them) in their local area. This choice requires careful research. However, seniors do typically save money by choosing Medicare enrollment, whether they select traditional coverage or Medicare Advantage!

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