Medicare Advantage Plans

Medicare Advantage plans, also called Part C, offer an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare, and they combine your Part A (hospital) and Part B (medical) coverage into a single plan. Many Medicare Advantage plans also include Part D prescription drug coverage along with extra benefits that Original Medicare does not provide on its own.

How Medicare Advantage Plans Work

When you enroll in a Medicare Advantage plan, you are still on Medicare, but you receive your benefits through the private insurance plan rather than directly from the federal Medicare program. You continue to pay your Part B premium, and some plans charge an additional monthly premium while others have a $0 premium. Each plan sets its own rules for how you access care, including provider networks, referrals, and prior authorization.

Most Medicare Advantage plans fall into one of two common structures. HMO plans generally ask you to use a network of doctors and hospitals and to choose a primary care physician. PPO plans offer more flexibility to see providers outside the network, usually at a higher cost.

What Medicare Advantage Plans May Cover

Beyond the hospital and medical coverage included in Original Medicare, many Medicare Advantage plans bundle in benefits such as:

• Prescription drug coverage (Part D)
• Dental, vision, and hearing benefits
• Wellness programs and fitness memberships
• Over-the-counter medication allowances and other supplemental benefits

Medicare Advantage plans are required to cover the same services that Original Medicare Parts A and B cover. However, how the benefits are designed varies from one plan to another. For example, one Medicare Advantage plan may have a $0 co-pay when visiting a primary care doctor and a $20 co-pay when visiting a specialist, while another Medicare Advantage plan may have a $20 co-pay for primary care doctor visits and a $40 co-pay for specialist visits. ClearGuide compares options and helps you find the plan that makes sense for your needs.

Understanding Costs and Out-of-Pocket Limits

Individuals enrolled in a Medicare Advantage plan may be responsible for deductibles, co-pays, and coinsurance when receiving services. Unlike Original Medicare, every Medicare Advantage plan includes an annual out-of-pocket maximum, which places a limit on how much you will pay for covered medical care each year. After you reach that limit, the plan pays 100 percent of covered services for the remainder of the year. Unlike Original Medicare Parts A and B, a Part C plan limits your total out-of-pocket Medicare-covered costs.

Comparing Medicare Advantage Plans

Choosing a Medicare Advantage plan shouldn’t end at comparing the monthly premiums. Important questions such as whether your doctors and preferred hospitals are in the plan’s network, whether your prescriptions are on the plan’s covered drug list and the cost, and the cost for different services you commonly use. A plan that initially appears inexpensive can cost more for the year than a plan with a higher monthly premium based on your care needs.

Reviewing Your Medicare Advantage Plan Each Year

Each year, during the Annual Enrollment Period (AEP) from October 15 to December 7, you can switch to a different plan for the following year. Regardless of your health conditions, you cannot be turned down. Because plan benefits can change every year, we recommend a plan review each fall, even if you are happy with your coverage, to make sure it will still fit your needs next year.

Working With an Independent Advisor

Because Medicare Advantage plans differ, having a Medicare advisor evaluate your needs and the various plan options on your behalf takes the confusion and anxiety out of selecting a plan. As an independent, carrier-neutral advisor, ClearGuide Advisors reviews options across multiple carriers and explains the tradeoffs, so you can choose a plan that fits your health needs and your budget.