For some of us age 65 or older, Original Medicare (Part A and Part B ) plus supplemental Medigap insurance provides all the healthcare coverage we need. However, others may want more benefits found in Medicare Advantage plans which technically fall under the heading of Medicare Part C.
Medicare Advantage plans provide Part A and Part B coverage as an alternative to Original Medicare. Medicare pays a fixed amount to private insurance companies, which provide benefits to each beneficiary enrolled in their plans. These companies must provide the same Part A and Part B benefits as Original Medicare but may also cover:
Like Medigap supplemental insurance, most Medicare Advantage plans cap out-of-pocket expenses. In addition, enrollees may have lower monthly premiums and other costs than Original Medicare.
While Medicare Advantage plans provide extra benefits, there are some restrictions:
Medicare Advantage Plans can differ in terms of how they offer benefits:
Medicare Advantage costs differ among plans. Insurers combine benefits to create offerings that differentiate themselves from their competitors.
Some plans pay for all or part of an enrollee’s Medicare Part B premium.
Deductibles vary. Higher deductibles often allow for lower copays or coinsurance.
Medicare Advantage Plans are not allowed to charge more than Original Medicare for some services like skilled nursing care or chemotherapy. Copays and coinsurance for out-of-network services can be higher for insurers with a dedicated network.
There are several options for Medicare beneficiaries to join, switch, drop or make changes to Medicare Advantage Plans. See the Medicare and You handbook for more details.
It usually encompasses the seven months beginning three months before age 65, the 65th birthday month and three months after that.
For Medicare beneficiaries who have Part A and are receiving Part B coverage for the first time during this period, a Medicare Advantage Plan can be joined with coverage starting July 1.
Medicare beneficiaries can join, switch or drop a Medicare Advantage Plan with coverage beginning January 1.
Those enrolled in a Medicare Advantage Plan can switch to another plan, drop a plan or return to Original Medicare.
In most cases, a Medicare Advantage Plan goes from January to December. However, for people experiencing certain life events (moving or losing other insurance coverage), they may be able to join, switch or drop a Medicare Advantage Plan during the year.
If you’re thinking about a Medicare Advantage Plan, first write down all your healthcare priorities. Items on the list could include:
Also, if a specific service, drug or supply item is needed, ask if it is covered by the plan.
A Medicare Advantage plan could be right for you. But, first, it is essential to compare different Medicare Advantage plans. Second, compare these plans to Original Medicare with supplemental Medigap insurance and stand-alone Part D Drug coverage. Once you have completed this thorough analysis, you’ll be better prepared to choose the right plan.
You can learn more about Medicare Advantage plans by visiting the Medicare website or downloading the latest Medicare and Me handbook. Also, look for my future blog posts on Sixty and Me for more valuable Medicare information. For an even deeper dive, check out my Medicare eBook at Living50+.
What questions do you have regarding Medicare Advantage Plans? Have you used it for your health needs? Why did you choose Medicare Advantage over Original Medicare?
Tags Medicare
I have read that when trying to go back to regular Medicare coverage after having been in a Medicare Advantage plan, it may be more difficult or expensive to get MediGap supplemental insurance coverage than if you had started out with original Medicare initially. Anyone have any information on this?
While Medicare Advantage plans are good for some I would recommend buying a supplement instead when affordable. I was always a fan of PPOs as I rarely had to use mine but one minor overnight hospital visit showed me how much out of pocket is required.
I have a special needs son in his 20’s and he get Medicare, is he eligible for a Advantage plan?
If he is receiving Medicaid, then probably not.
No he receives Medicare
Just because a plan says it offers something doesn’t mean it’s guaranteed. My plan offered free transportation in writing to a doctor’s office which I needed as I live by myself and had total knee replacement in my right knee. They refused the service for post op visits and to physical therapy as I lived in a “certain area.” I didn’t get physical therapy and now suffer with movement restrictions.
You might try medical escort services — not covered by any health insurance that I know of. However, if you live outside city limits or in a small town that probably won’t work for you. You can contact any Commission on Aging in your particular city/state to see if there are such services offered for free.
Medicare Advantage plans can be a good option for some beneficiaries as they offer all-in-one solutions, but it’s important to carefully review the plan’s details, coverage and providers before enrolling.
Medicare Advantage does not cover CPAP supplies for one thing.
Absolutely! You should also know that Advantage insurers have been investigated and are sometimes viewed as scams. See
https://www.npr.org/sections/health-shots/2022/12/12/1141926550/medicare-advantage-plans-overcharged-taxpayers-dodged-auditors
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html
That article says, “By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.”
https://www.newsweek.com/how-medicare-advantage-scams-seniors-opinion-1759368
This article goes right to the core of misleading advertising and outright deception.
Read these articles before choosing an advantage plan. I recommend working with a reputable insurance agent. Some will simply refuse to sell you certain coverage because they know it won’t help you.