What Is Medicare Advantage?

You’ve seen the commercials. You’ve gotten a hundred phone calls (daily). So what exactly are these Medicare Advantage plans that keep getting advertised to you? Are they as good as the commercials claim?

Medicare Advantage, also known as Medicare Part C, can be a great option for many people. But before you get caught up in the hype, you’ll need to understand how the plans work and decide if they’re a good fit for you.

How Medicare Advantage Plans Work

Medicare Advantage plans are one way beneficiaries can improve their coverage under Original Medicare. (The other option is called a Medicare Supplement plan.) If you enroll in an MA plan, your medical coverage will come from the company you choose to enroll with rather than the federal Medicare program. You will continue to pay the Part B premium, but your claims will be paid by your Medicare Advantage plan instead.

All MA plans must offer at least as many benefits as Original Medicare. (Except for hospice benefits, which will continue to be provided through Medicare Part A.) In addition, almost all Advantage plans include extra benefits you won’t find in either Original Medicare or a Medicare Supplement plan. Each plan is different, but most offer dental coverage, vision and hearing benefits, over-the-counter allowances, gym memberships, and more.

You will need to seek care from providers who are contracted with your particular plan. For this reason, we don’t often recommend Advantage plans to our clients in rural parts of the country. There are fewer providers to choose from, and the plan choices are limited. In urban areas, however, most providers accept MA plans, and there is a wide variety of plans to choose from.

The two biggest things you need to understand are the differences between the kinds of Medicare Advantage plans and the out-of-pocket costs. While most MA plans don’t have a premium, you should not consider the plan “free.” You will still pay for services you get while on the plan.

Should You Enroll in Medicare Advantage?

None of your Medicare choices should be taken lightly. They have the ability to greatly impact your coverage, and you can’t necessarily change your plan at any time. Here are a few questions to ask yourself if you’re considering a Medicare Advantage plan.

Provider Networks: Do my current providers accept the plan? If not, am I willing to change providers?

Costs: The Summary of Benefits will tell you how much certain services will cost. If you have upcoming treatment or know you frequently see a specialist, can you afford the copays? On the other hand, can you afford the higher premiums of your Medicare Supplement plan?

Extra Benefits: This is the last thing to consider, but review the extra benefits in your plan. Does it include dental coverage? What about prescription medications?

If you are someone who is considering enrolling in Medicare Advantage for the first time, you will have a 12-month Trial Right. This means that if, at any time during the first 12 months of the plan, you decide you’d rather return to Original Medicare with a Medicare Supplement, you are allowed to change your mind. Outside of that Trial Right period, you can return to Original Medicare, but you’ll need to be healthy enough to pass medical underwriting to enroll in a Medicare Supplement plan.

If you are currently enrolled in a Medicare Advantage plan or are considering enrolling in one, chat with the advisors at Sunflower Insurance Solutions. We’ll do a thorough evaluation of your medical needs and budget. Then, we’ll walk you through the pros and cons of each option so you can decide which one is right for you.