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How Do Medicare Advantage Plans Work? Originally Posted on June 21, 2012, last updated on October 17, 2013 and reposted on August 22, 2015

how do medicare advantage plans work

With the extremely high costs of healthcare, many seniors on Medicare are beginning to research how they can be in charge of their medical bills. They find that there are good reasons why you would opt for a Medicare advantage plan compared to other options such as supplemental insurance. So, how do Medicare advantage plans work?

When you’re initially become eligible for Medicare – for most people this is on their 65th birthday – you will have the option of enrolling in a Medicare Advantage Plan as an alternative. Medicare Advantage Plans assist seniors to get superior health coverage insurance with additional added benefits by minimized monthly premiums and out of pocket costs, such as deductibles, co-insurance or co-payments.

Original Medicare Part A and Medicare Part B are governed by the federal government, and were established as basic health insurance in the 70s. Bear in mind, those policies will not pay for all health care costs. Medicare advantage plans however are provided by private insurance carriers. Not every insurer may offer Medicare advantage plans: Insurance companies offering advantage plans must be authorized, and their plans must follow strict regulations. Medicare advantage is alternatively also known as Part C of Medicare. Advantage plans are offered to Medicare enrollees in return for their traditional Medicare insurance.

What Are Medicare Advantage Plans Exactly?

Medicare Advantage insurance policies are a different way to get Medicare health benefits. They substitute your original Medicare Part A and B benefits with coverage provided and paid for by a private insurance provider. The major characteristic of Medicare advantage plans are affordable rates together with expanded coverage. In addition, you will find another reason to favor a Medicare advantage plan: their guaranteed acceptance for any pre-existing health issues, with the exception of End Stage Renal Disease (ESRD). Because the premiums for such plans are driven by competition between health insurance providers, you may end up finding an easily affordable plan that will cover your health requirements far better than original Medicare insurance alone.

By law, all Medicare advantage plans must have benefits that are at least equal to those of original Medicare Part A and B. However, insurance companies are allowed to set their own price, which means the costs for each

plan will be different, while some Medicare advantage plans actually have no premium at all. Yes, Medicare advantage plans may be cost-free. They are referred to as ‘zero premium’ plans. The mix of private competition and government subsidies allows insurers to provide coverage for excellent health care, and at the same time help save retirees money.

On top of the medical services covered by traditional Medicare, numerous Medicare advantage plans provide further benefits to aid persons on Medicare with their overall health. You will find extra benefits included in most advantage plans, reaching from wellness programs to prescription drug coverage.


Given that all providers these days have websites, where the benefits and costs of available plans are outlined, it is fairly easy to compare different plans online. Most Medicare Advantage insurance policies are offered as Health Maintenance Organizations (HMO) plans, where members of the plan have to select from a system of health care professionals, or as Private Provider Organization (PPO) insurance policies, which give members the choice to use network providers for a lower co-payment, or out of network providers for a higher co-payment.

If you think of enrolling in an advantage plan, it is a good idea to research the directory of service providers first. You want to make sure that your doctor is actually participating in the network, as well as nearby medical centers. If your favorite health care providers are not part of the plan’s network, you either need to leave your doctor and switch to an in-network provider, or you will face out of pocket costs. Also, be prepared that with a HMO plan, you will have to select a primary care physician from the network, who has to give you a referral each time you need to visit a specialist or go to the hospital.

Medicare advantage plans are despite their limitations a popular choice, and currently nearly 25% of all Medicare beneficiaries are enrolled. Although the official website provides a lot of valuable information, you won’t find much about advantage plans, but you may visit other Medicare websites, such as to get your questions about advantage plans answered.

Originally posted 2012-06-21 09:22:25. Republished by Blog Post Promoter

Category: Insurance

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