PART 2: MEDICARE ADVANTAGE PLANS
And so we come at last to the plans that are currently generating enough paper advertisements to kill three trees for every American over the age of 55. So what are they?
Fundamentally, there are two types of Medicare plans:
× Medicare Advantage, or Part C plans and
× True Medicare Supplement, or MediGap plans
PART C: MEDICARE ADVANTAGE PLANS
As you’ve already guessed from the ‘Part C’, Medicare Advantage plans are indeed actually Medicare. That means that all Medicare Advantage plans MUST include all the benefits in both parts A & B. They can offer more, but they MUST cover at least as much as Original Medicare.
The key thing to understand about Medicare Part C – the Advantage plans - is that they are offered by private insurance companies. These plans are offered by EVERY private insurance company – Anthem, Blue Shield, Cigna, Health Net, Humana, Kaiser, United Health Care…it’s one very long list. When you sign up for a Medicare Advantage plan you sign away your actual Medicare benefits to the insurance company you’ve chosen. Medicare then pays the insurance company to manage your health insurance benefits. In return the insurance company pays your claims instead of Medicare. You still pay your Medicare Part B premiums but you may not have to pay an insurance company premium. Some Medicare Advantage plans still have a zero premium. In addition, many Medicare Advantage plans include EXTRA benefits not found in Original Medicare, e.g., dental, vision, or even chiropractic services. These extra benefits vary from plan to plan so be sure to check on the benefits the plan you’re interested in offers.
While there are a number of variations on the theme, Medicare Advantage plans typically fall into two categories:
× HMO and
Like any HMO, Medicare Advantage HMO plans require you to sign up for a Primary Care Physician (PCP). Your PCP is the gatekeeper for all your plan benefits. If you need to see a specialist or need any kind of test, you must first obtain a referral from your PCP. The up side, however, is that Medicare Advantage HMOs offer the greatest range of benefits for the lowest price. Medicare HMO plans are the ones least likely to charge a monthly premium.
If you’d rather go to your own doctor and not have to bother with the referral treadmill, then you can look into a Medicare Advantage PPO plan. As with the “regular” PPO plans you’ve known and…not completely hated… there are no gatekeepers or referrals to worry about. As long as your doctor accepts Medicare and is in the insurance company Medicare Advantage PPO network, you have nothing else to worry about. However, as with ‘regular’ PPO plans, you should expect to pay a higher percentage of your medical bills out of your own pocket than you would with an HMO.
Miscellaneous plans: There are some less common types of Medicare Advantage plans including (but not limited to):
Fee for Service
Key point: you MUST get your doctor’s agreement to accept Medicare EACH & EVERY TIME you see him. Doctors can decide at any time not to accept the plan.
Special Needs Plans
These are Medicare Advantage plans designed exclusively for people with chronic medical conditions, e.g., diabetes, congestive heart failure, HIV among
UPSIDES and DOWN
Medicare Advantage plans typically have low or even no premiums. They also typically provide genuinely comprehensive coverage with some plans even covering gym membership and other extras. That’s the upside: you get a lot of coverage for a very little money.
The downside is that the reason Medicare Advantage plans are cheap is because the government’s subsidizing them. So, since the government’s footing the bill, Uncle Sam gets to decide the hoops you have to jump through. That’s why all those ads are filling the airwaves and your mail box NOW – because this is the ONLY time of year the government permits you to make changes to a Medicare Advantage program. Miss the deadline that applies to you now, and you’re stuck with what you’ve got until next October.