Medicare Advantage Plans
Medicare Advantage Plans (also referred to as Part C)
Once enrolled in Medicare you will want to choose supplemental insurance, either (Avenue 1) Medicare Supplement + Part D Rx Plan, or (Avenue 2) Medicare Advantage. This page explains the details of Medicare Advantage plans.
Medicare Advantage plans, sometimes referred to as “Part C,” or “Not original Medicare,” are insurance plans for those age 65 or older and Medicare eligible (and even people under age 65 who are enrolled in Medicare). The plans differ from the Medicare Supplement + Part D plan coverage avenue in that the plan is “bundled coverage” The plan works in conjunction with Medicare to pay unmet costs at both the doctor’s office, hospital and pharmacy. One plan covers everything.
We Help Clients With These Medicare Advantage Plans (And More)
There are seven insurance companies offering PPO Medicare Advantage plans in our area; Aetna, Alignment Health, Blue Cross NC, CIGNA, Humana, UnitedHealthcare and Wellcare. We can offer information on all seven and help you compare.
A Quick History Lesson…
On How Medicare Advantage Plans Began Helps Explain How They Work
Medicare Parts A and B began in 1966, and then in the early 1970’s the Centers for Medicare and Medicaid Services (CMS) designed Medicare Supplement plans that insurance companies were authorized to offer, to help Medicare beneficiaries cover medical costs not covered by Original Medicare.
In the 1980’s CMS began to worry… soon the “baby boomers” would begin to turn 65, approximately 10,000 each day in the United States. Would the excellent claims system Medicare designed to process claims be able to handle the demand without problems?
CMS’s answer to that worry was the “Medicare Advantage” plan. If covered by a Medicare Advantage plan, Medicare’s claims system does not process your claims, then send to your insurance provider (like with Medicare Supplement). Instead the insurer offering your Medicare Advantage plan takes over for Medicare, processing and paying Medicare Parts A and B claims, then their own claims according to your policy.
Medicare sort of offloads you to an insurance company, and pays that insurance company a fee to handle everything, to lighten the Medicare claims load nationwide.
Medicare Advantage Plans Look A Lot Like Health Insurance Benefit-Wise, Copays for Everything
If you have ever been covered by a copay-style health insurance plan you will be familiar with the mechanics of how a Medicare Advantage plan works. There is a copay you pay, or percentage of the cost you pay, for each incurred medical service. The insurer pays the rest.
An Example:
Here’s a quick look at the plan benefits of a 2023 Medicare Advantage plan available in NC, to give you an idea. Ask today for a free quote and we will send you all the plan details.
Preventative Care: $0 copay
Primary Care Office Visit: $0 copay
Specialist Office Visit: $30 copay
Inpatient Hospital Care: $295 copay for days 1-5
Outpatient Hospital, Including Surgery: $195 or $295 copay
Diagnostic Tests: $20 copay
Lab Services: $0
Urgent Care: $40 copay
Emergency Room: $90 copay
Ambulance: $225 copay
Mental Health Office Visits: $25 copay
Prescriptions:
Preferred Generics: $0 copay
Non-Preferred Generics: $8 copay
Preferred Brand Name Rx: $47 copay
Non-Prefer. Brand Name Rx: $100 copay
Specialty Drugs: 33% of cost
Note, be sure to understand “Annual Out of Pocket Maximum”: The benefit detail we search for first when comparing Medicare Advantage coverage is the “Annual Out of Pocket Maximum,” or the most in out of pocket covered medical costs you could pay before the insurance company steps in and pays 100% for the remainder of the plan year. The plan example above carries an annual of out of pocket maximum of $3,900 annually, one of lowest in the area.
Medicare Advantage Plans Like to Offer “Extras”
Comparing available Medicare Advantage plans, the covered medical benefits start to look a lot alike, as many copays for the same medical services are similar. Because this is a very competitive insurance market, the insurers offering Medicare Advantage plans like to build in popular extra benefits; discount programs and extra benefits that pay for services we use, to stand out as the best choice. Each Medicare Advantage plan offers their own ideas of extra benefits. Here are the extras we see most:
Wellness Programs
Medicare Advantage plans offer access to wellness programs, coaching and other preventative services.
The one benefit in this category everyone loves is either a reduced cost or free gym (gyms, pools, Pilates studio, etc.) membership!
Dental Benefits
Many plans offer some dental coverage, including benefits for dental exams and cleanings.
A growing number of plans even offer coverage for dental services like cavities, root canal, crown, etc., paying up to $1k or $2k per year.
Vision Benefits
Since Medicare does not cover an annual eye exam many Medicare Advantage plans offer coverage for the exam after a copay.
Many plans also offer discounts or even true coverage on glasses and contacts, up to $300 per year.
Hearing Benefits
Many Medicare Advantage plans offer an annual hearing exam, either paid for or after you pay a copay.
In addition, insurers have built networks of providers to purchase hearing aids at a discounted or set, lower price per hearing aid.
Over the Counter Items
Most Medicare Advantage insurers now offer an “OTC benefit” providing you with a debit card in which they preload money quarterly.
You can utilize these monies for over the counter items you purchase like toiletries, vitamins, OTC drugs, etc.
Meals After Surgery
After an extended inpatient hospital or skilled nursing stay your first aim once home is rest.
Insurers try to lighten the load by delivery nutritious meals to your home for a period of time after your surgery or skilled nursing stay.
Medical Transportation
Many insurers feature free medical transportation as part of their “extras” package.
The insurer will pay a local service to drive you to medically necessary appointments, usually up to a maximum number of one way trips of 20-25 per year.
“Give Back” Benefit
Some insurers advertise a “give back” benefit…a dollar amount is added to your Social Security benefit each month, from $50 to $150.
Sounds great, but beware…these plans usually feature the highest maximum out of pocket cost, $8-$10k+!
Advantages / Disadvantage of Choosing a Medicare Advantage Plan
When you begin to research Medicare Advantage plans they seem great. You may ask yourself, “Why would I choose anything else?” We think that a careful comparison of the two avenues; Medicare Supplement + Part D Rx or Medicare Advantage, specific to your needs, usually yields the best answer. Here are some key details of Medicare Advantage (Part C) to watch for in your comparisons.
Advantages:
Cost!
The monthly premium cost for Medicare Advantage plans are much less than for Medicare Supplements. Medicare Advantage insurance plans in North Carolina mostly range from $0 to $55 monthly.
Extras
Medicare Advantage plans lead the way in offering “extras” to entice you to choose their plan…benefits like free or reduced cost gym memberships, dental , hearing and vision coverage, discounts and monies to pay for OTC products and other medical services not covered by Medicare, free meals, and even transportation to medical visits.
Disadvantages:
More Out of Pocket Expenses
The trade off for a lower monthly premium cost is that you will share more in medical costs as you incur them. There will be copays and percentages of cost (“coinsurance”) owed by you for each medical service in the Medicare Advantage plan design.
The good news is that you do know when the out of pocket cost ends, as each plan lists the maximum out of pocket cost borne by the insured, usually in the $3,900-$8,000 annually range.
Compare this to Medicare Supplement Plan G that pays the medical costs left behind for you by Medicare Parts A and B with just one exception, the $226 Part B deductible.
Fewer In-Network Providers
Unlike Medicare Supplement plans that have to adopt every Medicare provider as their network, Medicare Advantage insurers can build their own list of in-network providers that are usually smaller than Medicare’s network.
Medicare Advantage plans can also determine if their network is PPO or HMO. PPO plan networks are best….you can visit any provider you want to, but to get the bet benefits you need to visit an in-network provider.
Caution!: With HMO plan networks you must visit an in-networ provider to receive benefits. If you go to and out of network, there is not benefit! (as if you have no coverage at all!)
Free Information Packet and Quotes
Complete the form below and we will send you clear, concise information about Medicare Advantage plans, along with quotes to consider from insurance companies. We will compare the plans’ benefits and costs, and recommend what looks best based on your details and preferences.
Note: Privacy is something we take seriously, and keeping the information you shared private is of utmost importance to us. The minimum of information is shared with an insurance company to put together a detailed free quote and illustration for you.