Medicare Advantage. What It Means To You

Medicare Advantage plans (Part C) are privatized Medicare.  Insurance companies that have annual contracts with the Centers for Medicare AdvantageMedicare & Medicaid are allowed to offer your Medicare benefits, with most plans including prescription coverage.  They must offer all Medicare benefits and contain the same rights & protections of Medicare.  Rather than Medicare being your primary plan, the Advantage plan becomes your primary plan.  These plans typically are HMO, POS or PPO plans.  (HMO usually requires a referral before you see a specialist doctor & require you to always use network doctors unless it’s an emergency; POS is similar to the HMO but allows out of network coverage for some benefits; PPO plans allow you to see both in and out of network doctors typically with no referrals.)

How Medicare Advantage Plans Work 

Advantage plans are typically set up in a region covering several counties, or an area within the state, or the entire state.  When you enroll in an Advantage plan, should you move out of the plan’s service area, you will need to choose another plan for the service area of your new residence.  Most Advantage plans sold today utilize a network of doctors & hospitals for you to use.  They are contracted with the plan and agree to see you for the plan’s contracted rates.  Your charges (copays and coinsurance) are determined by the plan’s Schedule of Benefits.  For example, you may pay $10 to see a primary care physician, $25 to see a specialist, $250 for outpatient surgery, rather than paying the Medicare Part A deductible and Part B deductible & 20% coinsurance.  They are all required to have what is called an Annual Maximum Out of Pocket – this protects you against catastrophic medical bills, unlike Medicare Parts A & B.  This means your copays and share of the bills can never be more than the Annual Maximum, which is usually set at $6,700 or lower – depending on the plan you choose.  Outpatient prescription drug costs do not go toward your Annual Maximum Out of Pocket.

Medicare Advantage Plan Prescription Drug Coverage

If your plan includes prescription drug coverage, it must abide by CMS guidelines.  See the page for Part D Prescription Drug Plans.  Some plans will offer reduced costs for using their mail-order service, limited coverage through the Gap, or other savings for using specific preferred pharmacies.

What do Medicare Advantage Plans cost?

Medicare Advantage

Many plans are offered at $0 monthly premium.  You read that right!  How do they do that?  Medicare pays a fee to the insurance company each month for every member it enrolls.  The insurance company then uses that money to pay your claims and administer your plan.  And, the higher the plans star rating, the more money it receives.  Usually, but not always, plans with lower Annual Maximum Out of Pocket costs will have some type of monthly premium.  In Florida, most plan premiums range from $0 to $75 per month, but some are higher.  Downsides to an Advantage plan can be that they are managed care plans, and many services require prior authorization, and most HMO plans require referrals prior to seeing a specialist.  When enrolling, you agree to stay enrolled for the balance of the calendar year.  However, they are becoming more popular every year.  Many people like the fact that they only pay for the services they receive.  They also like the extra benefits that can be included (unlike with Medicare Parts A & B) such as: fitness club memberships, routine eye care, routine hearing & hearing aids, nursing hotlines, OTC benefits, foreign emergency benefits and more.

Which is better:  Medicare Advantage Plan or Supplement Plan?

Different strokes for different folks. 

A Supplement can offer better/more ease of use because there are no network limitations other than verifying the doctor/facility is participating in Medicare, and you can use it in any of the 50 states without checking in with the plan.  But all plans do have a monthly premium starting as low as $49/month and going up from there to about $250 or more.  (Costs vary by plan, age, area, health & tobacco status)

An Advantage plan can be great for someone that doesn’t use many medical services as you only pay for the services you receive.  Medicare AdvantageMany plans can be had for as little as $0 monthly premium.  However, all plans (with the exception of PFFS plans which are not very popular anymore) have networks, so to get the lowest costs, you will want to use in-network doctors/facilities.  HMO’s always require you to use in-network providers, except in the case of a life-threatening medical emergency and urgent care.  Also, many services require prior authorization, and many HMO’s require referrals to see specialty doctors.  But, they do come with extra benefits you don’t get from Medicare or a Supplement, like fitness club memberships, vision, hearing, etc.

The good news is that you can try an Advantage plan for a one-year trial and if you don’t like it, Medicare will allow you to enroll in, or back into, a Medicare Supplement plan anytime during the one-year period – no questions asked.  But it must be your first time on an Advantage plan, and there may be exceptions to this.

Contact Us For Your Medicare Advantage Insurance Needs

Our customer service doesn’t stop when your policy arrives in the mail.  We’re there for you year after year because as your needs change, so too should your Medicare Advantage Insurance Plans. We have met so many wonderful people in this community, and we look forward to meeting with you. Contact us today by completing our easy online request form  Give us the opportunity to work for you-you’ll be glad you did!


 

Medicare Advantage

Consultation is Free

By calling this number, I understand I will be directed to a licensed insurance sales agent. This is a solicitation of insurance. By providing this information, you agree that an authorized representative or licensed insurance agent/producer may contact you by telephone, email or mail to answer your questions or provide additional information about Medicare Advantage, Part D, or Medicare Supplemental Insurance plans.

Medicare Advantage

Medicare Advantage

Medicare Advantage

Our Reviews

My husband and I were referred to Kathy Thousand by a neighbor while being inundated with emails and mail from everywhere. We promptly made an appointment and were extremely pleased with her thorough knowledge as we were having a hard time on our own.I highly recommend Insurance Options and especially Kathy who made for an easy transition in the retirement phase of our lives.Roland & Elaine Figueredo
Elaine Figueredo
Elaine Figueredo
21:56 02 Nov 20
Kathy was fantastic! She answered all our questions and helped us navigate a real mess with great ease. She overcame obstacles that we couldn't deal with and we now have a great Medicare plan!
Lynne Woodman
Lynne Woodman
15:47 23 Oct 20
Kathy is professional, thorough and personable, too. A delight to work with to take care of my needs. Highly recommended!
Joe Kearns
Joe Kearns
20:21 20 Oct 20
I spent almost 2 hours with Kathy Thousand reviewing all of the supplemental insurance plans that fit me. Well worth the time!! I just recently retired and started my Social Security. She was very thorough and answered all of my questions. She is very good at what she does. I would recommend her to my family and friends.
Shirley Wheeler
Shirley Wheeler
19:45 05 Aug 20
All of my questions were answered with patience and professionalism, my needs and requests were addressed too. The office was clean and welcoming with protection for the Covid 19. I look forward to continue doing business there.
France Paulsen
France Paulsen
15:33 10 Jul 20
Melanie Mellars
Melanie Mellars
12:47 01 May 20
20 years ago the Thousand's wrote our health insurance plan which I have kept all these years. I can't believe the time has come for a new chapter, Medicare! Once again I feel confident that Kathy has done a wonderful job of finding the coverage's right for this phase of our insurance needs as well. Thank you for easing my apprehension regarding these insurance changes as well!
Paulette Halbrehder
Paulette Halbrehder
18:35 30 May 19
Margaret Schruers
Margaret Schruers
15:37 28 Nov 18
Complex...made very simple. Kathy Thousand was/is the best in her advice regarding Medicare Supplemental plans. Normally, choosing a plan is very complex and confusing...in her case Kathy explained in simple terms what care is best for me.I would give her 10 stars if that was possible!
Chuck Lind
Chuck Lind
15:00 25 Sep 18
Highly recommend.
Patricia Read
Patricia Read
11:09 23 May 18
Thanks Kathy for all of your help and guidance. I was defiantly going in the wrong direction. I guess everyones situation is different. It pays to see a pro.😲
Bill Mcginnis
Bill Mcginnis
20:38 21 May 18
Kathy was great, very helpful and took the time to educate me on Medicare supplements. I highly recommended mm no here.
Steven Huff
Steven Huff
16:42 09 May 18
Linda Hand
Linda Hand
20:06 04 May 18
I can’t say enough about the assistance with Kathy Thousands from Insurance Options, Inc. My husband and I are newcomers to Florida and MEDICARE. Kathy took as much time as we needed to make a choice for which Medicare supplement to take. She is a wealth of knowledge and information about all insurance options. Several weeks later, after we make our choice, we had more questions and again, she took her time and reviewed our program to ensure we were comfortable with our supplement choice. If you need any guidance with Medicare supplements or other insurance, please give her a call.....you won’t regret it.Five Star company, and Customer Service.....
Gail Mueller
Gail Mueller
16:00 24 Apr 18