Medicare Advantage Plans

Michael T. Braden, August 27, 2024 MEDICARE ADVANTAGE

Introduction To Medicare Advantage Plans, aka Medicare Part C

Medicare Advantage plans are not Medicare.  They are Medicare-inspired, Healthcare plans offered by private insurance companies.  These companies determine which procedures they will cover. There are limited networks, with annual Out-of-Pocket Expenses (MOOP) between $5,700 and $12,000. 

A Medicare Advantage Plan is a private health insurance plan approved by Medicare.  You have the option to receive your Part A, Part B, and Part D benefits from a Medicare Advantage Plan instead of Original Medicare.  Initially, these private insurance company offerings were referred to simply as Medicare Part C.Medicare Advantage plans typically have an HMO or PPO network of physicians and hospitals. All Medicare Advantage Plans are 80/20 plans, in which the insurance company pays 80% of covered charges, and you are responsible for paying your 20% share as you go. Each year, during the fall Annual Enrollment Period, you will need to choose a new plan for the coming year. 

MA and MA/PD (Medicare Advantage Plans) were created as alternatives to Original Medicare and Medicare Supplement/Medigap insurance.  By joining one of these plans, you direct Medicare to pay the Advantage Plan a set monthly amount for your care.  In return, the plan will deliver all of your Part A & Part B benefits and services.  Essentially, your care and services are managed by a private insurance company instead of the government.  The Insurance carrier assumes all risk. Unfortunately, each insurance company sets its own rules, and it has the final say on which procedures are covered and which are not.

You must continue to pay your Medicare Part B premium each month; you must be enrolled in Medicare Part A and Part B; and you must live in the Medicare Advantage Plan's service area.

Medicare Advantage plans are NOT Medigap plans.  They work differently because your insurance company pays all of your bills instead of Medicare, which means they also decide what they will and will not cover.

There are several significant advantages to choosing a Medicare Advantage plan.  First, most of their plans offer $0 monthly premiums. The majority of Medicare Advantage plans also include Prescription Drug coverage.  There are many other benefits, including Dental, Vision, and Hearing benefits, Over-The-Counter (OTC) Benefits, Transportation, and more.  

At Braden Medicare, we are contracted with leading Medicare companies that offer Medicare Advantage plans in Arizona. It is essential to mention that we do not offer every plan available in every county in the United States. Any information we provide is limited to those plans we do offer in your area.

Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all of your options.”