A Medicare Advantage Plan (MA Plan), also called Medicare Part C, is a program that gives you a chance to get your Original Medicare Parts A & B through a private health plan rather than through Medicare itself.
Original Medicare is a federal, health insurance program for those who are 65 and older, or for individuals who are disabled. Original Medicare is:
1. Medicare Part A, which is hospital insurance
2. Medicare Part B, which is medical insurance.
Once an individual is eligible for Parts A and B, they then have the option to consider a Medicare Advantage Plan. These private companies combine Parts A and B into one plan, along with a Part D drug plan. Not all plans include Part D, but many do. These plans may even offer additional benefits beyond Medicare Parts A and B, such as dental coverage, hearing and vision benefits, gym memberships, and over the counter supplements. Lastly, if you decide to enroll into an MA Plan, you do not need to enroll into a Medicare Supplement plan.
Medicare Advantage Prescription Drug Plans
As previously mentioned, many Medicare Advantage plans incorporate a Part D prescription drug plan. In doing so, you would have all four parts of Medicare in one plan – Parts A, B, C & D. These kinds of plans are called Medicare Advantage Prescription Drug (MAPD) plans as they consolidate both prescription drug coverage and health coverage into one plan. To simply matters, you’ll have all four parts in one ID card.
Regardless of what kind of Medicare Advantage plan you may pick, you must reside in the plan’s service area and keep paying your Medicare Part B premium each month. For many enrollees in Maine and New Hampshire, there are MAPD plans that have no additional monthly premium to join.
Comparison of Medicare plans
Medicare Advantage plans differ in coverage, cost, and availability based on the state and area in which you reside. Within a given state, each plan is Federally regulated on a county by county basis. It is suggested that you should review all available Medicare Advantage plans in your area before you select a medical plan to meet your needs.
The following list is far from complete, but here are important items you should take into consideration when choosing a plan:
HMO vs. PPO plans – Each has pro’s and con’s,
Prescription costs and coverage,
Monthly premiums and maximum out of pockets.
It is highly recommended that you work with a licensed and certified agent to ensure that your plan selection meets your needs. It is certainly a possibility that one spouse could choose one plan, while the other spouse selects a different plan. Adding to the confusion is that MA plans change each year! Again, by working with an experienced, professional agent you can assured you’re in the right plan each year.
“Positives” of Medicare Advantage plans
1. Medicare Advantage plans frequently provide additional benefits beyond Original Medicare,
2. Monthly premiums can be significantly lower than a Medicare Supplement with a Part D plan,
3. HMO Medicare Advantage plans coordinate your care, often saving you out of pocket expenses,
4. Medicare Advantage plans can simply your insurance needs into one company,
5. Plans provide additional benefits beyond Medicare, like gym memberships, vision and dental care, and over-the-counter supplements.
“Negatives” of Medicare Advantage plans
1. The plan may have an unfavorable doctor network, including significantly higher out of pocket expenses if you go out of network,
2. Medicare Advantage plans may not cover your medication (Always check the formulary before an enrollment),
3. Plans may require referrals,
4. Be mindful of the “Max Out of the Pocket” limits, which can change every year.
5. Higher out of pocket costs for hospitalizations, skilled nursing care and cancer treatments.