Medicare Advantage Plans

Formerly known as Medicare Part C (Medicare + Choice) the programs called Medicare Advantage plans (MA plans) are an alternative to having Medicare as your primary insurer and purchasing a Medigap or Supplemental plan as a secondary insurer. Any Medicare recipient enrolled in parts A & B are eligible for a Medicare Advantage plan but must reside in a company’s service area. In addition to that, you may not have end-stage renal disease. You can typically enroll in a Medicare Advantage plan even if you have existing health problems, except for end-stage renal disease. (You can continue in the Medicare Advantage plan if you develop end-stage renal disease while you are in the plan however.)

Medicare Advantage plans are available from private insurance companies that contract with the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. These “contracts” with Medicare, that insurance companies negotiate annually, allow insurers to reserve the right to alter or discontinue plans in a given area each year. Medicare pays the Medicare Advantage Company of your choice a set amount each month in return for them overseeing your healthcare as the primary insurer. You pay your monthly Medicare Part B premium in addition to any additional premium the Medicare Advantage plan charges.

Many companies offer “MA” plans in states all across the nation but they are “county” or area specific plans. The plans have at least the same benefits as Medicare Part A (hospital coverage) and Part B (doctor / outpatient medical coverage) and can include additional benefits, such as the Medicare Prescription Drug Coverage (Medicare Part D). The plans that include the drug benefits are MA-PD plans. However, the prescription drug plan can offer fewer options for the “perfect fitting” plan than choosing a stand-alone Part D plan that might be available to you. You must take whatever RX plan the Medicare Advantage Company offers. Accepting another company’s prescription plan will disenroll or “kick you out” of the current MA plan you have. Exceptions to this rule would be someone enrolled in a group or retiree Prescription Plan, or receiving VA prescription benefits, government assistance or state run programs such as PACE / PACENET in Pennsylvania for example. In those cases, you would be able to maintain your MA plan and have a different RX benefits package.

They can designate areas of coverage, cost of various plans, benefits, deductibles, co-pays and doctor networks. All of these things can and usually do change each year. You must also choose to use a doctor in the network as you Primary Care Physician (PCP) also known as the “Gatekeeper”. The main premise is that through preventive care and the use of a primary physician who acts as a "gatekeeper" prior to sending a patient to a specialist for care, health care costs can be reduced while beneficiary health can be maintained.

Overall, Medicare Advantage plans can be a viable alternative for a Medicare recipient in some cases where health status and finances might be an issue. They can also offer benefits such as basic dental coverage and discounts on eyeglasses, hearing aides and fitness centers. However, some things to keep in mind when purchasing an MA plan: coverage co-pay and deductible costs, referrals, networks, and “lock in periods” that keep you from changing coverage until the annual open enrollment period.