Medicare Advantage Plans are simply a different way to receive your Medicare benefits, through private insurance.

The Parts of Medicare are as follows:

Medicare Part A = Hospital coverage.

Hospital coverage means “Inpatient,” or being actually admitted to the hospital.

Medicare Part B = Doctor coverage.

This also includes “Outpatient” coverage, or any surgical procedure that does not require you to be admitted to the hospital overnight. Radiology, Labs, ER, and Chemotherapy are also covered under Medicare Part B.

Medicare Part C = Medicare Advantage
(A + B = C)

Medicare Advantage is another way of receiving your Medicare Benefits. Instead of Medicare paying claims directly to the doctor, Medicare pays each private insurance company a flat monthly fee to dispense your Medicare benefits through a structured health plan. Medicare Advantage Plans are usually HMOs.

By managing the medicare benefits through an HMO, this can lower costs for the member, often for little to no extra premium.

Part C usually includes D (Prescription coverage)

Medicare Advantage Plans usually include Part D coverage.

Medicare Part D is prescription coverage.  Part D plans must be purchased through private insurance. If you have Original Medicare only, or Original Medicare plus a Supplement (Medigap plan), you must purchase a separate stand-alone drug plan.

Many people like the fact that their prescription drug plan is bundled with their Medicare Advantage Plan.

Reasons to Like Medicare Advantage

Affordability: usually the number one reason people choose Medicare Advantage. Medicare Advantage offers additional coverage over and above Medicare, often for no extra premium.

Part D is included. Most Medicare Advantage plans include Medicare Part D. Stand-alone drug plans usually cost more than Medicare Advantage Premiums.

Some people like HMOs, because they get help managing their health care. The primary doctor tells you what specialists to see, and usually sets up the appointments for you. All of your care and health records are contained within one “Health Maintenance Organization.”

Cap on annual spending: Medicare Advantage Plans offer an annual “out-of-pocket” maximum for copays and coinsurance. That means there is a cap, or cut-off point to how much you are required to spend in a calendar year. Many people don’t realize that Original Medicare (Parts A & B only), offers no spending cap. Your potential out-of-pocket costs on Medicare alone are unlimited.

(Not all Medicare Advantage Plans are HMO’s).