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Do people like Medicare Advantage?

Here is a full list of questions and answers:

The first question we hear quite a bit is, “Do people like Medicare Advatage?”  More people are familiar with Medicare Supplement Insurance plans, so when one of our agents describes Medicare Advantage (or Medicare Part C), this is the next logical question we hear.

My answer would be as follows: As with anything, some people like Medicare Advantage and others do not. And, the reason one person likes it can be the same reason another person does not.

Without giving an opinion, here is a list of the things that make Medicare Advantage different from original Medicare and, in some cases, from Medicare Supplement Insurance plans:

1. Prescription Drug coverage: Most Medicare Advantage plans include prescription drug coverage, which means you may not have to write two premium checks or sign up for two different plans like you do with a Medicare Supplement plan – one for the drug coverage and one for the medical coverage.

2. Monthly premiums: In some cases Medicare Advantage plans cost $0 per month in premium beyond what you’re already paying for Medicare Part B. In other words, you could sign up for the plan and pay nothing extra each month to maintain your coverage.

PlanPrescriber did a high-level review of all Medicare Advantage plans available nationally using the Center For Medicare and Medicaid Services (CMS) Landscape Data files, which are available publically online at: .

That review showed that, among the 43,329 plans available nationwide for 2012, 14,297 plans (33% of all plans available) have a monthly premium of $0 above what a person would already pay for Medicare Part B. And, the data showed that there were $0 premium plans available in 49 states, the District of Columbia and Puerto Rico.

However, plans with $0 monthly premiums may not be available in every county. Among all plans available, the average monthly premium was $57.56, per month.

 3.  Out-of-pocket limits: “Original Medicare,” Parts A and B, do not place a cap or limit on what you might have to pay out of your own pocket for medical expenses. But, the Patient Protection and Affordable Care Act (health reform) did place a mandatory maximum limit of $6,700 on all out of pocket medical costs for Medicare Advantage plans.

This limit is referred to as the “Maximum Out of Pocket” or MOOP.

The MOOP does not include prescription drugs and monthly premiums. The Mandatory Maximum Out of Pocket (MOOP) is $6,700 but Medicare allows for a “Voluntary MOOP” of $3,400 or less. And, when we looked at the 2012 data we found that, of the 43,329 plans available nationwide, the average maximum out of pocket, or MOOP, was $4,516.

4. Dental, Vision, etc. Benefits: Some Medicare Advantage plans will cover things like routine vision and routine dental care, as well as benefits like audiology services and fitness classes. The majority of Medicare Advantage plans include the Medicare Part D prescription drug benefit.

  5.  Flexibility: Unlike Medicare Supplement plans, in every state a person can change their Medicare Advantage plan once a year without undergoing medical underwriting. In most states, a person with a Medicare Supplement plan has only a seven month window to enroll in a Supplement plan. After that “initial enrollment period,” a person’s application for a Medicare Supplement plan can be declined.

In any state, a person with a Medicare Advantage plan can change their coverage during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 in 2012. People are encouraged to at least check their drug coverage and benefits once a year while on Medicare, as the prescription drug  and other benefits tend to change from year to year.

There may be additional opportunities to change coverage throughout the year based on individual circumstances. For example, in 2012, anyone with access to a Medicare Advantage or Prescription Drug Plan with a “5 Star” rating will be able to enroll in that plan at any time throughout the year.

6. Variable Plan Types: In the past, Medicare Advantage plans were often available primarily as HMO plans where services were provided through a specific network of doctors and hospitals that often required referrals to see specialist. Medicare Advantage plans are becoming increasingly  available as; Preferred Provider Organizations (PPOs), which offer a wider choice of providers; Private Fee-for-Service (PFFS) plans that don’t typically have networks, however, providers must accept plan payment and rules; and Special Needs Plans (SNPs) specifically designed for people with lower incomes and/or specific diseases or conditions.

Links to other Medicare Advantage FAQs:

Medicare has not reviewed or endorsed this information

Category: Insurance

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