Your Quick Guide to Medicare Advantage Plans
Medicare Advantage plans were designed to provide Medicare patients with an alternative to Original Medicare and act as such. These plans look and feel like a major medical you may have had through an employer or individual in that they have cost-sharing amounts you are responsible for. Some of these would include doctor visits, outpatient surgeries, and lab and X-Ray. These advantage plans can also add some extra features you may not have with original Medicare for things like preventative dental, vision, and transportation expenses. And, most advantage plans (MAPD Plans) will include Medicare part D within the plan’s framework.
Unlike Original Medicare where the claims for insurance are filed directly with Medicare, a Medicare Advantage Prescription Drug Plan (MAPD) will directly negotiate with the provider, be it a hospital or regular Physician, and those claims will be filed directly with the Advantage carrier and the provider, effectively bypassing Medicare. For this reason, these plans are also known as Medicare replacement plans. MAPD’s effectively replace Original Medicare, so you do not need to present your Medicare ID card when seeing a provider. You will only present the health plan card to your provider if under an Advantage plan.
Advantage plans are designed to provide you with all your Medicare Approved Hospital, medical, and prescription costs at a low or 0 monthly plan premium which can run you less per month as opposed to Original Medicare with a supplemental plan. However, the plans are currently networked and will either utilize an HMO or a PPO network. HMOs are much more restrictive than PPO plans and require you to see a doctor inside the network. If the provider you wish to see is not in the network then the insurance carrier will not pay. PPO plans, on the other hand, allow you to see any provider in or out of the network. For those providers out of network, you would be assessed a higher co-pay or coinsurance amount than if the same provider was in network. For this reason we typically recommend a PPO over an HMO MAPD if there is one available in your particular area.
Also unlike a Medicare Supplement policy, an Advantage plan may leave you with several thousand dollars of out of pocket exposure should you get sick or go into the hospital. Advantage plans are required to cover exactly what Medicare covers or better. But, these plans have varying degrees of out of pocket exposure for doctor visits, hospitalization, surgical procedures, and the like. There will be a stop loss on your copayments you are exposed to. Most plans are required by Medicare to leave you with no more than $6700 dollars of exposure in the network and no more than $10,000 dollars out of network cost sharing exposure. We do carry gap products to assist you in covering this expense should you get sick or be admitted to the hospital. Please complete a contact form on the website to have one of our agents send you a quote for Medicare Advantage along with these gap plans.
Medicare places rules for enrollment into MAPD plans and also provides Medicare beneficiaries with an Annual Enrollment Period. The AEP(Annual Enrollment Period) runs from October 15th of each year to December 7th. This may be the only time seniors currently enrolled under and Advantage plan can make a change to another plan or go back to original Medicare with a supplement and stand-alone Part D drug plan.
You may make as many selections as you like and the last enrollment request Medicare receives by the deadline on December 7th is the plan you would be enrolled under for January 1st of the following year. Another time you have to enroll is during a Special Enrollment Period (SEP) or your Initial Coverage Election Period(ICEP). SEP will allow you to enroll in an Advantage plan but only within 63 days of a qualifying event. Or, you may enroll 90 days prior to and 90 following your initial coverage under Medicare. Usually, this period will occur around your 65th birthday as Medicare will begin the first day of the month in which you turn 65. One of our AHIP certified agents will gladly review your eligibility in a plan if you care to.
Not only do your advantage plans combine hospital, medical, and prescription drugs but, often times they’ll offer some limited dental, vision, and even transportation coverage. Original Medicare does not cover dental, vision, or transportation while most advantage plans integrate at least one or more of these items. Typically the coverage for dental and vision is only preventative in nature and will not cover things like root canals and crowns. However, the cleanings and possibly some of the basic dentistry might be covered under the plan. Many people find these extra benefits to be appealing in light of their exclusion from Original Medicare and value the added coverage brings against the high cost of cleanings, eye exams, and dental x-rays, etc. For availability, you may certainly run independent quotes before speaking with a licensed expert by clicking HERE. Or, you may call us for an appointment at your convenience to speak with a licensed AHIP certified agent who will gladly go over your options over the telephone when you’re ready, on your terms!
Medicare Advantage Plans tend to be less valuable to clients who have high medical and hospital bills. Most of our clients who have pre-existing medical conditions or who anticipate having some major health issues in the future are advised to take a strong look at Original Medicare along with the Medicare Supplement and Stand-Alone Part D drug plan as the most valuable choice when it comes to your Medicare spending dollars. This is because Medicare is accepted at more providers at a national level than MAPD plan networks and, the Supplement is truly designed to work seamlessly with Original Medicare, leaving you with fewer Medical bills on average than an Advantage plan would look like. With an Advantage plan you’d always be contending with co-payments and co-insurance amounts not covered by your plan each time you see a provider, especially being specialist providers.
If you are comfortable taking that risk and like the way Advantage plans charge you less each month then by all means jump on board. There truly is not “wright or wrong” when it comes to purchasing a Medicare plan. The decision to obtain coverage from Original Medicare or to carry an MAPD is all up to you and how much exposure you are willing to risk should you get sick and need to see a doctor. One of my highly skilled and friendly agents can assist you in determining which insurance choice would be best for you based on your personal situation by asking a few simple questions. Feel free to call us when your ready or, call us if you’d like us to run a quick quote. Or, you can always click the link HERE to view various Medicare plans and download an outline of coverage or pricing for you and a spouse. Or fill out one of our easy to find contact forms to be contacted at a later time to discuss all the options related to Medicare gap products available to you on the market. Our agents will call you back just as soon as you are available to speak about these very important decisions. We write Medigap and MAPD business in several states including Texas, which is where we have a physical location, and Louisiana, New Mexico, Utah, Oklahoma, Florida, Tennessee, Arkansas, Colorado, and Virginia. We are happy to serve you this year and each year thereafter to ensure you are taken care of and have a plan that suits your needs and budget. This means regular reviews by one of our award-winning and licensed customer service staff and before and after the initial sale when one of our agents in our sales department walks you through the process of enrolling in a Medicare Plan. We thank you for the opportunity to serve you and look forward to years of service to you!