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Medicare Advantage Plans Explained and 5 Great Tips For Choosing One

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Government insurance can be a complicated insurance to navigate, but in its simplest form, you have two options. Your first option is to take the standard insurance with Part B and a drug plan. Secondly, you can take a Medicare Advantage plan offered by an outside insurance company who has a federal contract to offer you insurance.

Medicare Advantage plans (also known as MA plans) were introduced in 1997 by Bill Clinton. They were re-branded in 2003 from Medicare+Choice, being renamed Medicare Advantage, also known as Part C. Clinton wanted to give people more choices for their medical insurance and open up more doors to treatment.

What Are Medicare Advantage Plans?

MA plans are private plans offered by individual health insurance companies. CMS does not dictate to them or mandate what they will and won’t cover. The plans must offer the same basic things that non MA plans would, but beyond that, it is up to the insurer. 

Regional and Inclusive

MA plans are regional and sometimes only usable in your zip code. The plans are most often all inclusive (some are not, but we will touch on that a little later on). The plans offer you most of the benefits you would get by going the traditional route, but there are also extras offered such as dental and vision which are not offered on traditional plans. Let’s break it down a little further.

Medicare Advantage Plan Explained

Say you are a 65-year-old man readying for retirement. Overwhelmed and inundated with calls and mailers advertising all the services offered to people entering the autumn years. 

After sitting down with an insurance sales agent, they give you the benefits, facts and choices for insurance coverage, which are:

– Traditional insurance with Parts A (hospital coverage) and Parts B (health insurance) (part B is also optional)
– A prescription drug plan (optional)
– MA plans with or without drug coverage (also called Part C) 
– Supplemental Insurance

The only insurance you are required to have if you’re planning on drawing your SSA check is part A and that is free. 

Advantage Plan Versus Traditional Plan

Remember, you can’t have a traditional plan and an Advantage plan together, as a MA plan replaces traditional government insurance and farms your insurance coverage out to a private company.

After considering the options and benefits -and calling your doctor to make sure they accept the insurance- you enroll in an Advantage plan understanding that if you wish you can get off the plan you can do so, only at certain times of the year when an enrollment period is available. 

What Are The Requirements?

To qualify for a MA plan, you must meet the following conditions.

1. You must enroll in both Medicare parts A and B
2. You must be 65 or older, under 65 and disabled or meet the requirements for a special needs plan 
3. If you have ESRD (end stage renal disease) you may not qualify for a MA plan.
4. Be in a service area accepting new patients

It is important to note that these are the general guidelines, but most people will qualify for a plan. It is important to note that if you are signing up with a company you’ve had previously, you may have to pay them any outstanding balances owed and the first month’s premium before you can get coverage.

CMS has no say in whether you can have a plan. You are signing up for a private health insurance plan, so what they say goes, period.

How Much do Medicare Advantage Plans Cost?

Medicare Advantage plans will vary in cost depending on the plan you choose. Keep in mind that the cost of your Advantage plan is in addition to the cost of your Part B Medicare coverage. As of 2022, Part B costs $170 a month.

Advantage plans are not typically very costly, with some starting as low as $25 a month. Talk to an insurance agent you trust, as they will help you find the best plan to fit your needs.

How Are MA Plans Different to Non MA Plans?

With a traditional plan, you do not have access or limited access to dentists and opticians. Original Medicare barely covers anything for those services. However, with MA plans, if they offer it, you can buy standalone vision and dental.

Some companies have basic vision and dental in their plan. I stress that it is basic, so you can not be reliant on the “free dental” you must purchase add- on plans if offered. 


Prescription Drug Coverage

With prescription drugs, you have the choice to buy a plan with or without drug coverage. This is a tricky aspect to navigate and the medication that you take and the price charged for it will determine your choice. With traditional Medicare, they too offer standalone drug plans which have the same challenges. 

Coverage Area

In speaking about challenges, the big difference -and a bone of contention for many- is coverage, or where you can use the insurance. All Medicare patients face these challenges regardless of what insurance they have.

The problem is that doctors can choose what insurance they take, or if they take insurance at all. Medicare and the Government do not, and can not dictate what insurance a healthcare worker will take so there can be difficulty in using the insurance. 

In terms of difficulty, while it may be a benefit to have local coverage, this presents a problem when traveling. With traditional insurance you can use this wherever you want in the country- so long as the doctor accepts it. But with MA plans, they restrict you to one geographic area except with emergency -but you may have a higher out of network rate to pay.

What Are the Benefits of Non-traditional MA Plans?

MA plans have many benefits to offer the insured by offering the basic services not given by traditional insurance such as vision and dental and allow cheaper rates when going to the doctor. Also, most Advantage plans have copay rather than coinsurance, so you know what you will have to pay before going to a clinic, which is important if you are on a fixed income.

5 Tips for Choosing the Best Medicare Advantage Plan

If you are nearing retirement age, it is time to start thinking about your Medicare options. There are many different plans available, and it can be difficult to decide which one is right for you. In this blog post, we will discuss 5 tips for choosing the best Medicare Advantage plan.

Plan Costs

The first thing you should look for when comparing plans is the cost. Remember that your health insurance coverage will affect how much you pay for doctor visits, hospital stays, prescriptions, preventative care, and more.

The Medicare website offers a helpful tool to compare costs and plan features in your area. You can use this tool to find the best value for your individual needs. Planning ahead can help you find the plan that is right for your budget.

 Plan Availability

It is important to consider where a plan will cover you, and if it has any limitations on where doctors are located. If you have a specific network of physicians or health care providers that you prefer, make sure that they participate in your plan’s network.

It is a good idea to ask your current physician about the plans they offer before you make a decision. If you prefer a certain hospital, consider using this facility for your primary care. Your plan should also be available in the area where you currently live and work.

 Health Statistics of the Local Population

Local health statistics are important when considering the quality of care that your plan offers. You can gain information about the health of the local population by finding research on the hospitals and providers in your area. The Centers for Disease Control and Prevention (CDC) will give you valuable data on illness and disease rates, treatments, drug resistance, and more.

 Medical History and Preferences

Before choosing a Medicare Advantage plan, you should reflect on your medical history and any preferences that you have for doctors or hospitals. You may also want to consider what preventative care is most important to you. For example, if staying healthy with regular checkups and screenings is a priority, look for a plan that offers these services at little or no cost.

 Your Priorities

While thinking about your medical history, it is important to remember that your plan should empower you with choices. Keep in mind what you would like to have the most control over when choosing a Medicare Advantage plan.

For instance, if you are self-disciplined enough to keep track of deadlines and coordinate appointments by yourself, you may want to go with a plan that does not require an annual wellness visit. If you value the opinion of your primary care physician over convenience, then it will be important for you to find a plan that gives you access to one easily and without extra costs.

Medicare Advantage to Meet Your Needs

The best Medicare Advantage plan for you is the one that meets your needs. Remember to take cost, availability, health statistics, and medical history into consideration when making your decision. Lastly, keep your priorities in mind when choosing a plan that will be able to accommodate all of your individual needs!