What is a Medicare Advantage Plan

Medicare advantage plans are offered by private insurance companies to augment coverage provided by Medicare. It should be noted that Medicare Advantage Plans must be approved by Medicare, so make sure to do your research.

A prerequisite for joining a Medicare Advantage Plan is enrollment in both Medicare's Plan A (hospital insurance) and Plan B (medical insurance), including urgent and emergency care. The major benefit not covered by a Medicare Advantage Plan plans is hospice care. This is not a conce
as hospice care is covered by Original Medicare.

So what does a Medicare Advantage Plan offer?

Many plans offer extended coverage in areas such as: hearing, vision, dental, general examinations (check-ups) and a variety of health and wellness programs. Prescription drug coverage is also covered under most plans. Some plans require that one choose one of the vendors' primary care physicians. This physician must also be used for referrals. You may also be limited to the insurance provider's list of doctors, hospitals and any other required medical facilities.

There are other plans available that offer the consumer flexibility in the choice of health care providers. Private Fee-For-Service plans, for example, may allow the plan holder to choose any doctor or Medicare approved hospital. The limitations of these plans is that there may be a co-payment for doctor visits and some health care providers may be unwilling to see you. The advantage of this plan is that one can choose a desired primary care provider.

The Majority of Medicare Advantage Plans fall under what is known as “managed” care plans. What this means is they usually incorporate a broad selection of beneficial services. Some plans may include services such as: general checkups, diagnosis and treatment of illness (including necessary tests, doctors’ visits, prescription medications, and hospital care), preventive care and immunizations for adults and children and complete pregnancy and newbo
care. The majority of managed care plans also offer some services for the diagnosis and treatment of mental health issues and substance abuse problems.

Another benefit of managed care plans is preventative health care services. These services are designed to help with lifestyle choices that can keep one from developing many preventable conditions such as, high cholesterol, high blood pressure, and diabetes. If susceptibility is identified early, many of these conditions may be treated before they become serious health issues.

There are also cost saving benefits associated with managed care plans. By making arrangements with regional hospitals and doctors they are able to control the fees they charge. This may result in cost savings for consumers, be it employers or individuals.

Medicare will not contribute anything towards a Medigap plan, but will contribute a fixed amount each month to your approved Medicare Advantage Plan. Payment of doctors, hospitals and other healthcare providers is then the responsibility of the Medicare Advantage Plan.

Even though a Medicare Advantage Plan is required to follow the rules laid out by Medicare, they may still charge a premium and any out-of-pocket expenses. Co-payments resulting from a doctor's visit or co-insurance payments for medical equipment such a wheelchairs will result in out-of-pocket expenses being charged back to the consumer. There may also be yearly deductions for prescription medications. It should also be noted that payment for Medicare's Plan B monthly premium will be deducted from social security checks.

If you live in an area where a Medicare Advantage Plan is accepting new members and you are enrolled in Medicare's Plan A and Plan B, you are free to join. Check to make sure that the county you live in is covered, as sometimes coverage is not statewide. Search online for plans in your area and see if there are upcoming seminars where you may speak with representatives.