The Secrets of Medicare Advantage Plans

(WHAT I WISH SOMEONE WOULD HAVE TOLD ME AT AGE 65)

Here are some general “good things to know about Medicare Advantage Plans”

  1. A Medicare Advantage Plan is one of two choices that I have when I reach the “T” in the road when I turn 65 and go on Medicare Part B.  If I do not choose Original Medicare, then I would choose a Medicare Advantage Plan.
  2. A Medicare Advantage Plan (MAP) is another Medicare health plan choice I may have as part of Medicare. MAPS are sometimes referred to as “Part C” of Medicare or “MA Plans”.
  3. Medicare Advantage Plans are network plans.  I must live in the service area of the plan to join.  When I join, I will receive a provider directory of doctors/hospitals that I can use.

In all MAPS, I am always covered for emergency and urgent care.  If I go to a doctor, facility, or provider that doesn’t belong to the plan, my services may not be covered, or my costs may be higher.

  • MAPS are “pre-packaged plans”.  In other words, the insurance company offering the MAP has already pre-selected the doctors, hospitals, and prescription plan that I will use.
  • Many MAPS offer extra coverage not covered in Original Medicare such as vision, hearing, dental, and/or health and wellness programs.  This coverage is also listed in the provider directory.
  • Some MAPS are premium free plans.   This means that outside of the monthly social security deduction for Part B, I pay $0 for the plan.  Instead, what I do pay are deductibles and co pays whenever I receive a service through a plan provider.
  • If I join a MAP for the first time, and am not happy with the plan, I will have special rights to buy a Medigap policy and return to Original Medicare within 12 months of joining the MAP.
  • I can only join or leave a MAP at certain times during the year. I do not have to answer medical questions or go through underwriting to switch to a different MAP.

If however, my MAP decides to stop participating in Medicare and no longer offers service in my area, then I will have the option of joining another MAP or returning to Original Medicare.

  • Since some MAP’s are premium free, many people feel that this is “free health care”.

They fail to consider that when they become ill, there may be doctor/hospital co pays and deductibles.  It is important to read the plan details to determine what my actual costs will be when I become seriously ill.

  • Unlike Medicare supplement plans, Medicare Advantage Plans are not standardized.

Written by Medicare Expert Andy Lockridge

Therefore, these plans can charge different out of pocket costs and have different rules for how I get services (like whether I need a referral to see a specialist of if I have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or urgent care).

These rules can change each year.

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