Medicare Advantage Plans

Man lifting a hand weight thinking about Medicare Advantage plans.
Medicare Advantage Plans may provide a more tailored solution to your insurance needs.

Medicare Advantage Plans are health plans that are approved by Medicare and provided by private insurance companies. Medicare pays money to private insurance companies to provide your Medicare benefits. These plans are sometimes referred to as “Medicare Replacement” plans and are Part C of Medicare. They must cover at least what Medicare covers, so you don’t lose anything, but they set the rules for how you receive your care.

When you enroll in a Medicare Advantage (MA) or Medicare Advantage with Prescription Drugs (MAPD), you are still enrolled in Medicare, but the plan provides all of your Part A (hospital), Part B (medical) and Part D (drug) benefits.

Almost all Medicare Advantage plans include Part D (prescription drug coverage) and some offer extra benefits like dental and vision.

You Can Enroll in a Medicare Advantage Plan If…

  • You live in the plan’s service area and
  • You have Medicare Part A and Part B

Advantage Plans are a good way to cover yourself if you like to save money on insurance because you rarely use it. Having an Advantage Plan puts a cap on your financial responsibility in case something does happen.

How Medicare Advantage Plans Differ from Original Medicare

Medicare Advantage plans are different from the Original Medicare program. Below are some key points to understanding how they work.

  • You must continue to pay your Part B premium.
  • You do not use your Medicare card. Instead, you use your plan’s ID card at the hospital, doctor and pharmacy. Your providers bill only your single insurance company.
  • All services have a copay (primary care visit, specialist, x-ray, blood work, in-patient hospital stay, physical therapy, etc).
  • You should NOT have an Advantage Plan AND a Supplement/Medigap.  The two are either-or coverages and cannot work together. If you have both, the MAPD is the only one that will work.
  • There are usually benefits above what Medicare covers such as dental, vision, hearing, and OTC allowance.
  • Every plan has an annual maximum-out-of-pocket which puts a limit on your financial responsibility.
  • Every plan has a network of doctors. There are two types of networks: HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization).
    • With an HMO, you can only see doctors in the network. If you go out-of-network, you pay 100%.
    • With a PPO, you can go to doctors in or out of the network. If you go out-of-network, you will pay a higher copay, but still have coverage.

Make Sure to Do An Annual Review with Imagine Insurance Advisors

There are two times during the year that you can change your Part C Medicare Advantage Plan (outside of a Special Enrollment Period, like moving out of the service area or receiving Extra Help.)   The main enrollment period is the Annual Enrollment Period (AEP), from October 15th to December 7th for a January 1st effective date.  The other is the Medicare Advantage Open Enrollment Period (MA-OEP), from January 1st to March 31st for an effective date of the 1st of the next month.

We recommend evaluating your coverage every two years as the copays, networks and drug coverage can change. Imagine Insurance Advisors offers a complementary review of your plan. We can make sure your doctors are still in-network and that your medications will continue to be on the formulary. We are appointed with all the carriers in our area to ensure you get an unbiased recommendation. Contact us to get your free review, we are here to help!