Medicare Advantage Plans:
A Medicare Alternative

Newsletter Issue #5

As President of MediGap Advisors, I believe in providing our clients with a wide range of options when it comes to health care. In last month’s newsletter, I explained the different Medicare supplement plans and how they cover the out-of-pocket costs left behind by Medicare. I would now like to introduce to you Medicare Advantage plans.

Medicare pays individual insurance companies a fixed amount each month to provide coverage for Medicare beneficiaries in the form of Medicare Advantage Plans. Premiums are typically low, and sometimes even $0, you just pay your normal Part B premium.

What’s the Advantage with a Medicare Advantage Plan?

Original Medicare has three parts – Part A for hospital, Part B for outpatient, and Part D for prescription. Medicare Advantage plans combine all of these services into one plan. Most plans operate by requiring Medicare beneficiaries to pay copays rather than deductibles and coinsurance, which can be a huge savings considering the Medicare Part A deductible is $1,632 (for 2024).

Some Medicare Advantage plans also offer additional benefits not covered by original Medicare such as:

Working Within a Network

Medicare Advantage plans work a bit differently than original Medicare. To maximize your coverage with original Medicare, it’s important to use Medicare participating physicians – that is – physicians who accept Medicare “allowed amount” or contracted amount. With a Medicare Advantage plan, access to physicians is limited to a network.

Each Medicare Advantage plan consists of a list of network providers – providers that are contracted with the insurance company to provide care for its members. As the insured, it is in your best interest to choose your physicians from the network list as many plans do not cover services provided by an out-of-network physician.

Some plans also require you to choose a primary care physician who then acts as a “gatekeeper” and coordinates all of your health care. In these instances, referrals are required to see specialists and to receive care provided by caregivers and facilities other than your primary care physician.

If you would like to continue with your current health care providers, it’s important to check the plan’s network list before signing up to ensure your physicians are contracted with the Medicare Advantage plan of your choice. There are numerous Medicare Advantage plans to choose from in each demographic area, so chances are your physicians likely participate in at least one of the Medicare Advantage plans available.

Prescription Coverage to Complete Your Medicare Advantage Plan

Prescription coverage is usually included with most Medicare Advantage plans. Each Medicare Advantage plan has its own formulary – or list of covered medications. Medications not included in the formulary are usually not covered at all or require prior authorization due to special circumstances. To maximize your coverage, it’s best to have your physician order medications contained on your plan’s formulary.

If you have medications that you take on a regular basis, it’s best that you compare Medicare Advantage plan formularies to ensure your medications are covered. Physicians are usually willing to accommodate patients to help them save money by writing for generic or formulary medications – you just have to ask.

Medicare Advantage Enrollment Periods

Of course, you can always sign up for a Medicare Advantage plan during your initial Medicare enrollment period, which runs from three months before the month you turn 65 until three months after the month you turn 65. You can also choose to switch from original Medicare to a Medicare Advantage plan during Medicare’s annual enrollment period, which runs from October 15 to December 7 each year.

If during your initial enrollment period, you choose to go with original Medicare combined with a Medicare supplement plan, you should weigh all of your options before dropping your supplement plan and moving to a Medicare Advantage Plan.

Remember – during your initial enrollment period, Medicare supplement plans are guaranteed issue – meaning you can’t be denied coverage due to a pre-existing condition. If you move to a Medicare Advantage plan and then decide to move back to a Medicare supplement plan, you could be subject to underwriting and could be denied coverage if you have any pre-existing conditions.

Trust Your MediGap Advisors’ Personal Benefits Manager

My goal at MediGap Advisors is to help you keep more of your money in your pocket – where it belongs! Your Personal Benefits Manager can show you all of the Medicare Advantage plans available in your area. You’ll also have access to provider network lists and prescription formularies before choosing a plan. Your advisor has years of expertise dealing with Medicare and will be sure the entire process of choosing a plan is easy and hassle-free.

Next month I’ll talk about how to choose between a Medicare supplement plan and a Medicare Advantage plan.

Best regards,

Wiley P. Long III
President – MediGap Advisors