Medicare Advantage Plans
Medicare Advantage Plans – also called Medicare Part C – involve medical and prescription copays, ask that you seek scheduled care in a specific network of physicians/hospitals, and act as primary insurance. Primary insurance means that you do not use your Medicare card when seeking healthcare, but rather the insurance company’s Medicare card. Medicare Advantage private insurance plans cover the same medical needs that government Medicare covers.
The good news on Medicare Advantage is that many of these plans have no monthly cost for the insurance premiums – meaning that you often do not have to pay a premium to the insurance company to receive this coverage. Further, many of the plans include valuable ancillary benefits beyond what Medicare covers, such as: free annual allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and no-cost gym/YMCA benefits.
Generally speaking, with Medicare Advantage plans, by not paying any insurance premiums, you should expect to save significant money versus paying insurance premiums for Medicare Supplemental coverage and stand-alone Part D drug coverage. The insurance premiums savings can often exceed $2,500 per year, which is substantial. In return for these insurance premiums savings and to enjoy the ancillary benefits (dental/vision/hearing/OTC/gym), you must be willing to accept copays and seek care in a specific health network.
A Good Review of Medicare Advantage plans (Medicare Part C plans) should include the following:
- What is the price range in your county for monthly premiums for various Medicare Advantage plans?
- What are the co-pays for Medicare-covered services? What is the plan annual out-of-pocket maximum cost for medical co-pays?
- Are your favorite local doctors and hospitals in-network?
- What are plan co-pays for generic and name-brand prescription drugs? Will the Medicare Advantage plan cover your specific prescriptions?
- What is the prescription drug “donut hole” and might it impact you? What would drug costs be in this “donut hole”?
- Does the plan include benefits beyond Medicare, such as: quarterly allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and Silver Sneakers gym/YMCA benefits?
- How much might you save annually by enrolling is a Medicare Advantage plan, and not enrolling in a Medicare Supplemental Plan G and a Part D drug plan? We will help you put a number on this.
So Which Insurance Strategy is better – Medicare Advantage or Medicare Supplemental?
For most persons, there isn’t necessarily a right or wrong answer, so mostly it comes down to your feelings towards what role you want health insurance to play in your life. Do you want to save maybe $2,000 in annualized insurance premium payments and live with reasonable medical copays….or would you rather pay for the insurance and get rid of most of the medical costs?
- Medicare Advantage can work if this is you: “ I’d rather save maybe $2,000+ per year in insurance premiums (by not using Medicare Supplemental). I’ve studied the Medicare Advantage plan co-pays, the plan’s physician/hospital network, and I can live with them. I also want to take advantage of some dental coverage, eyeglass coverage, OTC supplies at no cost, and use Silver Sneakers to hit the gym or YMCA.” If you feel this way, then Medicare Advantage can offer great coverage.
- Medicare Supplemental coupled with a Part D prescription plan can work if this is you: “ I want the freedom to seek care at every hospital and see any Medicare-accepting doctor in any state. With Medicare Supplemental Plan G, I don’t want to see any Medicare medical bills or copays, beyond a $226 Year 2023 annual Medicare Part B deductible. I want Medicare and the Medicare Supplemental insurer to pay the medical bills, except for that Part B deductible. I am willing to pay reasonable monthly premiums for this insurance coverage and I will also pay insurance premiums for the Part D drug plans. The structure of this coverage gives me a greater peace of mind.”
At Penn Health Insurance Solutions/Penn Medicare Solutions…we have had this conversation several thousand times these past fourteen years, and we will be happy to have it with you!
“John helped me change Medicare plans so that I am saving money.”
– Carl B., Woodbury Heights, NJ