What Is Medicare Advantage & Should I Consider It?

One of your options when you are turning 65 or going on Medicare for the first time is Medicare Part C (Medicare Advantage). These plans replace traditional, or “original” Medicare (Parts A & B), and all of your benefits are provided through the private insurance company. They work very differently from original Medicare and Medicare Supplement, or Medigap, plans. So, it is essential to understand all of the implications of this type of plan prior to going this route.

Medicare Advantage is, essentially, a privatized version of Medicare. It provides all of your medical benefits, and many of the plans also include Part D (prescription drug coverage).

What Does Medicare Advantage Cover?

Medicare Advantage plans vary greatly. In most areas, particularly urban areas, there are 3-5 (sometimes, many more) options for Medicare Advantage coverage. Plan coverage varies from one company to another – in other words, they are not standardized like Medigap plans. The plans have co-pays, deductibles and coinsurance for various procedures and services.

They are required to publish a “Summary of Benefits” as part of their enrollment information that details exactly what the premiums, co-pays and coverage limitations/restrictions are for the plan. It is important to study this document in detail for any plan you are considering.

What Plans Are Available in My Area?

This varies greatly from one area to the next. Many areas, particularly in the Northeast US, FL and CA – areas in which Medicare Advantage is more popular, have 10 or more plans to choose from. However, in some parts of the country, there are a very limited number of plans.

The easiest way to see which Advantage plans are approved for your county is to go to Medicare.gov. There, you will find a listing of all of the plans available in your county, as well as some basic information about what they cover and how they work.

Do the Plans Have Networks?

Medicare Advantage plans, generally speaking, do have networks. These plans are typically either HMOs or PPOs, meaning that they have a network of participating providers. These networks change from time to time, including during the year (although you cannot change plans during the year on Medicare Advantage), so it is vital to stay apprised of the plan’s network, including any changes to that network.

How Can I Compare Medicare Advantage Plans?

Comparing Medicare Advantage plans, like comparing Part D plans, is important. Whereas with Medigap plans, you are comparing primarily price, since coverage is standardized, Medicare Advantage plans require a careful comparison of both price and coverage. The plans vary greatly, and they can have some significant out of pocket exposure or risk – so it is important to understand how they work.

Medigap-Quote.com has chosen not to continue to offer these plans due to client feedback and other recurring factors. If you want to go the Medicare Advantage plan route, we recommend comparing the plans on www.Medicare.gov.

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