Medicare Advantage Plans Part C
Advantage plans are an alternative to Original Medicare (ALL Medicare Advantage plans must include everything that traditional Medicare covers). If you choose to enroll in an advantage plan then you will assign Part A and Part B of Original Medicare over to the insurance company you enroll with, who will then become your primary health care provider instead of Medicare. These plans are usually less costly than Original Medicare. Advantage plans are available based on the state and county you live in. Therefore not all plans are available in all counties. Along with this, premiums may vary with each county. If you choose an advantage plan they combine your medical and prescriptions coverage into one bundle, this is called an MAPD.
One major reason people choose advantage plans is they are able to offer additional benefits at no extra charge. Some of the common extras include: silver sneakers (health club membership), vision, hearing, and dental.
Before choosing an Advantage plan over Original Medicare some things to consider are:
Does your doctor accept the plan?
Is premium a concern to you?
What is the maximum out-of-pocket you can afford?
Are all your medications covered on the plan?
Do you travel or live part time outside the service area?
Do extra benefits matter to you?
Each company that offers Advantage plans has a directory of doctors that have signed an agreement to accept the plan. You must use these doctors unless it is an emergency. Therefore you will need to make sure that your doctors are in the directory for the plan you want, or that you are willing to choose new doctors. If you are a person who has a lot of health problems and uses many specialists an Advantage plan may not be right for you.
Most advantage plans are a zero premium, or low cost (unlike a Medicare Supplement). A major thing to note is that you must pay a co-pay to see a doctor, or to have tests and services. You would also have a deductible for hospitalization. These all would contribute to a maximum out-of-pocket cost. The maximum out-of-pocket is different with every company; however CMS has mandated that HMO’s have a maximum out of pocket to be $7,550 or less per year.
Much like a PDP the Advantage plans change the drug formularies every year. This means that the best plan for you may change year to year. As a result it is very important to do an analysis every year to make sure you stay on the best and most affordable plan for you. Doctors can also decide to not accept the plan from one year to the next as well, which is why our analysis includes looking up your physicians.