Medicare Advantage Senior Assistance Guide

Are you confused about the Medicare Advantage program? In this simple, easy-to-understand guide, you'll learn the pros and cons to get a head-start on making the wisest decisions for you and your loved ones.
Word picture around Medicare with all its various components

Are you curious about the Medicare Advantage Program? New guidelines. New programs. New regulations. If you’re feeling a little confused, you’re not alone. That’s why it’s time for a Senior Assistance Guide.

In this overview, you’ll learn the most important facts about the Medicare Advantage program. You’ll discover the pros, the cons, and key insights to give you a head start on understanding the landscape.

Let’s dive in.

What Is Medicare Advantage?

Medicare Advantage is a plan that’s a private health insurance plan, approved by Medicare. You can choose to get your Part A, Part B, and D benefits from a Medicare Advantage plan instead of traditional Medicare.

I don’t know about you. But I like to refresh my mind with a quick review of a ‘glossary’ of terms.

Medicare Part A is hospital insurance.
Medicare Part B is medical insurance.
Medicare Part C, aka Medicare Advantage, makes it possible to receive Medicare benefits in an alternative way.
Medicare Part D is prescriptions.

As a Medicare private insurance plan, Medicare Advantage plans usually have an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) network of doctors providing care. Members get their care from this network of doctors and hospitals.

Medicare Advantage policies are not Medigap plans. They work in a different way. Simply, they pay instead of Medicare, not after Medicare.

Depending on your lifestyle and personal preferences, you may find Medicare Advantage plans attractive — or not.

What Are The Pros of Medicare Advantage Plans?

Provide More Benefits

Medicare Advantage Plans often offer more benefits than you’d receive under the Original Medicare. This varies amongst plans, so be sure to review options directly. The additional coverage may include routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership.

May Cost Less

When enrolling in a Medicare Advantage plan, you’ll continue to pay your Medicare Part B premium, plus an additional premium. This varies from one plan to another. Some plans offer premiums as low as $0.

Maximum out-of-pocket expenses are limited. Once you’ve spent the maximum amount, you’ll not have additional covered medical services for the remainder of the year.

Often a Medicare Advantage plan can be less expensive compared to staying on Original Medicare.

Coordinate Care Among Your Providers

Coordination of care can be a huge convenience, and a valuable asset for peace of mind. Typical plans have networks of contracted health care providers, often with a Primary Care Physician, who helps coordinate your care.

One Stop Center for Health and Prescription Needs

You might prefer working with one plan administrator. Most Medicare Advantage plans combine medical and Part D prescription drug coverage. A one-stop approach also coordinates the delivery of added benefits, such as dental, vision and hearing care.

What Are The Cons of Medicare Advantage Plans?

Limit Your Freedom Of Choice

With Medicare, you can usually go to doctors and facilities that accept Medicare. However, Medicare Advantage plans are more restrictive. You are covered by terms that apply to their provider networks.

If you go outside of the network, your plan may not cover costs. Additionally, your costs may not apply to your out-of-pocket maximum.

May Require Referrals and Authorizations

To prevent misuse, Medicare Advantage plans often require prior authorization for services such as hospital stays, home health care, medical equipment or complex procedures. The plan may require a referral from your primary doctor to see specialists. This can create a cumbersome and tedious process in order to guarantee services are covered.

Regional Networks, Not Nationwide

Most plans work with regional networks of participating providers. This means that you must reside in the specific advantage plan’s service area for at least 6 months of the year.

If you travel frequently, divide your time amongst different regions, this requirement may be problematic or prohibitive.

What Are Key Considerations?

With over 4,700 Medicare plans nationwide, you have a lot of options to consider. You may want to do some initial research online. Simply start with typing in your zip code to explore plans that are available in your area.

If you are considering Medicare Advantage plans, talk with your friends, families and colleagues. Get a realistic sense of what works, advantages, disadvantages, and whether their choices will truly work for you.

Additionally, experts recommend that you interview a licensed insurance agent about different plans in your area. You may have specific health care needs that direct your choices.

Assistance Club Summary

The bottom line? Medicare Advantage plans may provide more affordable coverage than the Original Medicare. However, you will need to meet the plan’s rules to receive payment for services.

With a healthy bit of research, you’ll find the choice that best matches your personal needs and lifestyle.