What is Medicare Advantage?

Why should you enroll in Medicare Advantage?

After learning the needs and experiences of local populations, private companies develop Medicare Part C plans. By offering a comprehensive array of choices, this arrangement provided the means for customization of additional benefits.

Although Medicare Advantage plans must meet standards of Parts A and B, they can often do more. Typically, Medicare Advantage plans provide coverage and benefit options that Original Medicare excludes from coverage.

Depending on your circumstances, needs, and preferences, there may be many benefits and cost savings with Medicare Advantage compared to other options.

Having Medicare Parts A and B covers 80% of the cost for medically necessary inpatient hospital or outpatient medical services.

On the other side of the coin, the remaining 20% is left to the beneficiary, who must decide how to face out-of-pocket expenses when they arise.

As a rule, Original Medicare sets no annual limit on the dollar amount spent to meet the 20% leftover for medically necessary services. For this reason, Medicare beneficiaries often choose a plan to help with these costs.

Expressly, Medigap and Medicare Advantage comprise the different types of Medicare health plans.

What are the different types of Medicare Part C plans?

While Medicare Part C plans differ by price and service features, all plans provide benefits equal to or greater than Medicare Parts A and B combined.

Predominantly, selections offer plan types mainly defined by their networks of doctors and facilities.

Namely, different Part C plan types include: 

• Health Maintenance Organization (HMO): these plans require members to get care and services from providers in the plan’s network, and require a referral from an in-network primary care doctor for specialist visits.
• Preferred Provider Organization (PPO): these plans allow members flexibility to get care and services from providers both in and outside the plan’s network, and do not require referrals for specialists. Seeing providers outside of the network typically costs more.
• Special Needs Plans (SNP): these plans serve a narrow group with a wide array of services aimed at their specific needs. Special Needs Plans cover services for those with a common illness that requires regular treatment, such as for lung disease. They add specialists and medical resources tailored to their care needs. All SNP plans must provide Medicare prescription drug coverage built in.

Within each of these plan types, many insurance carriers offer considerably varied plans.

Additionally, it is important to note that while most Medicare Advantage HMOs and PPO typically include Medicare Part D prescription drug coverage, not all plans do.

More often than not, if a person joins a Medicare Advantage plan that does not include Medicare prescription drug coverage, they cannot join a separate Medicare drug plan (Part D).

Typically, the options for Medicare Advantage plans vary from county to county. To find the selection of plans that serves your area, enter your zip here and we’ll do the rest.

Is it better to have Medicare Advantage or Medigap?

In a nutshell, Medicare Advantage and Medigap are different ways of controlling Medicare costs.

Often, Medigap policies come at a high premium, and are sometimes underwritten for health conditions, depending on age and eligibility. Mainly, these policies excel at reducing out-of-pocket costs for medically necessary services.

Chiefly, Medigap policies are supplemental to Original Medicare, meaning that they only pay for services and supplies covered under Parts A and B. 

On the other hand, Medicare Advantage is the privatization of Original Medicare under a private insurance company. With Medicare Advantage, the benefits are paid for by the private insurer, and the plans themselves must cover all benefits included in Original Medicare.

However, unlike Medigap, which helps pay for expenses under Parts A and B only, Medicare Advantage plans can offer benefits beyond Original Medicare, such as dental, vision, and hearing as well as prescription drug coverage.

In many cases, Medicare Advantage can include Part D prescription drug coverage, and many offer a $0 or low-premium month to month.

However, not all Medicare Advantage plans include Part D prescription drug coverage. Depending on your situation, that may be the best fit.

To find out at no cost, enter your zip to see the array of plans offered where you live!