medicare advantage

Medicare Advantage (MA) is sometimes referred as a Medicare Health Plan or Medicare Part C.  It is a different way to get your Medicare.  Medicare Supplement plans are good way to cover what Medicare does not pay.  However, for some people, Medicare Supplement plans are not affordable.  Also, because of the medical underwriting, even people that can afford Medicare Supplements are not able to sign up for supplements if they already have some pre-existing conditions.  So, Medicare created another option called Medicare Advantage.

Medicare Advantage can only be obtained from Private insurance companies.   These plans include Medicare Part A (Hospital) and Part B (Medical).  They also can include Medicare Part D (Prescription Drug).  A Medicare Advantage plan without embedded prescription coverage is referred as a MA Only plan.  If the Medicare Advantage plan includes prescription, then it is referred as a MAPD (Medicare Advantage with Prescription Drug).  When you sign up for a Medicare Advantage plan, it becomes your primary insurance.  You only need to provide your Medicare Advantage insurance card to providers you visit.  Medicare no longer will pay benefit (one exception is hospice).  That is because Medicare will pay a set amount of money to the Medicare Advantage plan and passes the liability to the private company. 

These private companies must sign a contract with the Federal Government and the plans must follow strict guidelines setup by Medicare.   The Medicare Advantage plans must cover all the benefits of Original Medicare but many of them offer additional benefits. 

Here are some reasons people enroll in Medicare Advantage plans:

1. Plans are very affordable – Because Medicare pays the private insurance companies, many Medicare Advantage plans does not charge you additional premiums (You pay $0 monthly premium). You must continue to pay the Original Medicare Part B premiums.
2. Many Medicare Advantage plans eliminate the Medicare Deductibles and you only pay a copays (instead of 20% coinsurance) for many services.
3. Medicare Advantage have a lot of extra benefits not offered by Original Medicare. Here are some of the extra benefits you can get.  However, keep in mind that not all Medicare Advantage plans offer all of these benefits. 

• Vision
• Dental
• Hearing Aids
• Transportation to Medical Appointments
• Gym Membership
• Credit for Over-the-Counter items
• Worldwide Emergency Room coverage
• Telehealth (Doctors by teleconference)
• Meals (After hospital stay or Skill Nursing stay)
• Rewards for doing preventive services (like gift cards)
• Acupuncture
• $0 Cost Generic Drugs

To qualify for a Medicare Advantage plan, you must meet three criterias:

1. You must live in the plan Service Area
2. You do not have End-Stage Renal Disease (kidney failure)
3. You must have an enrollment period

You must live in the plan Service Area

All Medicare Advantage plans cover a service area.  The service usually includes a specific number of counties.  If you don’t live in one of the counties listed in the service area, you cannot sign up for that particular plan.  In Colorado for example, some plans service area includes all the Denver Metro counties.  You must live in the Denver Metro counties in order to enroll in those plans. 

You do not have End-Stage Renal Disease (kidney failure)

Medicare Advantage has one pre-existing condition.  Anyone with End-Stage Renal Disease (kidney failure) is not able to join a different MA.  If a person develops the condition after being enrolled in a Medicare Advantage plan, then the plan must cover the condition.  The plan cannot disenroll the person and the person won’t be able to join another Medicare Advantage plan from a different company. 

You must have an enrollment period

Medicare allows enrolling or changing plans only during a valid enrollment period or a qualifying event or circumstance. 

You can find a lot more information about Medicare Advantage plan at medicare.gov.

There are many companies that offer Medicare Advantage plans.  I am contracted with most of them but it is not practical to contract with all of them.  In most cases one of the companies I represent has the lowest out-of-pocket cost (or very close to it).  When considering a company, many people stay with the same company they have with their employer coverage.  Employer group plans and Medicare Health Plans can be very different coverage even with the same insurance company.  You want to pick a company that best fit your current situation (budget, health, traveling and more).

Here is a list of companies and Plans I can help you sign up for: