Medicare Advantage

Medicare Advantage

What exactly is a Medicare Advantage plan? What does it cover, and how is it different from Original Medicare or a Medicare Supplement plan?

The first thing to understand is that a Medicare Advantage plan is NOT the same thing as a Medicare Supplement. Medicare Advantage, technically speaking, is Part C of the Medicare program. As such, Medicare Advantage plans provide healthcare coverage mandated by the federal Medicare program. In other words, if Medicare says something must be covered, then the Medicare Advantage plan must also cover the treatment, test, therapy, etc. In many cases, an advantage plan can include Part D, which will cover your prescribed medications. Lastly, in order to join a Medicare Advantage plan you need to have Medicare Parts A and B in place, and live in the plans service area, which are defined as counties in each state.

In general, if you are an individual who would like to eliminate or dramatically reduce co-pays, deductibles, and out of pocket costs for doctors, specialists, and hospitals then you should NOT enroll into an advantage plan, but rather join a Medicare Supplement, such as Plan F or Plan G. These plans come with approximate premiums of $185-225/month, depending on the company and plan you choose. Again, paying this premium will mean an insurance company will cover the costs that Medicare has passed on to you. Remember, if you would like Rx coverage you need to purchase a Part D prescription plan, where premiums range from $15-100/monthly – most enrollees pay between $30-50/monthly. Remember, supplements no longer cover prescriptions!

In terms of a Medicare Advantage plan, the monthly premiums in some cases can be dramatically lower than supplements, such as $0/month. Some plans have higher premiums, but generally an advantage plan should be much lower than the monthly costs of a supplement with a Part D drug plan. In exchange for the benefit of lower monthly premiums, you will have co-pays, deductibles, and co-insurance percentages to pay when you visit medical providers.

Examples of co-pay costs for Medicare Advantage plans will resemble the following:
Primary Care Doctors $0-20
Specialists $20-45
ER Visits $75-100
Hospital Stays $250-350 for days 1 thru 7
Preventive Care $0

Each plan decides what your co-pay or deductible will be for a given service. Some co-pays are very modest, like $0 for preventive care, while other co-pays can be significantly higher, like skilled nursing facility care or cancer treatment.

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