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Medicare Basics

Intro to Medicare Advantage Plans

Medicare Advantage plans, also known as Part C, closely resemble traditional medical insurance. Beneficiaries choose from a variety of plans offered by a number of insurance companies. Each plan must provide, at minimum, the same coverage offered by Medicare Parts A and B, with one exception. Medicare Advantage (MA) plans do not have to cover hospice care (although some do include this coverage). Many MA plans offer additional benefits, such as dental, vision, and prescription drug coverage.

What Is Medicare Advantage?

Many private insurance companies offer Medicare Advantage plans, with the most common being health maintenance organizations (HMOs) and preferred provider organizations (PPOs). These plans provide the same hospital and medical coverage found in Original Medicare, but many people prefer MA, as these plans typically require lower out-of-pocket costs along with improved benefits. For example, many MA plans include prescription drug coverage, saving beneficiaries the added confusion of choosing a Medicare Part D plan.

HMO plans include a network of providers, from doctors to clinics to hospitals. Members must visit in-network providers to ensure coverage. PPO plans also have a network of preferred providers, but members willing to pay a higher co-pay may choose to go out of network.

Medicare Advantage does not allow beneficiaries to purchase a Medigap policy to help defray their out-of-pocket costs. However, the plans place a limit on these costs. Plans may change from year to year. These changes may include premiums, covered services, and provider network. Beneficiaries are encouraged to review their MA options every year.

The Benefits of Medicare Advantage Plans

One of the main reasons Medicare beneficiaries choose MA is to lower their healthcare costs. You still have to pay the premium for Medicare Part B, but even then, MA premiums are often lower, especially when you combine the Medigap policy premium with your cost for Parts A and B. Another potential savings is the out-of-pocket max, which varies from plan to plan. Once you reach that total, you have no further expenses for that calendar year. Original Medicare does not offer this benefit.

Members also appreciate the cohesiveness of an MA plan, which typically includes a single card, as well as a solitary system to navigate. This is especially true for new members coming off a standard employer-provided insurance plan. Most Medicare Advantage plans closely resemble this type of coverage, and that familiarity makes them popular with many recent retirees.

Of course, after worries about costs, it all comes down to benefits. While most MA plans must include coverage included in traditional Medicare, most offer benefits that are more robust. Dental, vision, and hearing are not included in Parts A and B, but many MA plans offer this coverage. In addition, many include prescription drug coverage.

Finally, many beneficiaries like the coordinated care aspect of Medicare Advantage, especially if they choose an HMO plan. On these plans, members choose a primary care physician (PCP) from their provider network. Your PCP coordinates all aspects of your healthcare, an especially helpful feature for members with complex health issues.