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Medicare Advantage plans are an alternative to Original Medicare, Part A and Part B. Instead of having Medicare benefits administered through the government-run program, beneficiaries can choose to get their coverage through a Medicare Advantage plan, available through private insurance companies that contract with Medicare (Government). Medicare Advantage plans are different from Medicare Supplement plans. Some doctors refer to them as Medicare replacement plans or Medicare replacement insurance. These plans often have networks and some plans may require you to get referrals to see a specialist.
Below is the current Medicare Advantage Statistics in our Nation (according to Kaiser Family Foundation):
Medicare Advantage plans has grown in the Medicare program over the past decade and will continue to trend in the Medicare Arena. More than 22 million Medicare beneficiaries are enrolled in Medicare Advantage plans as of 2019. Medicare Advantage plans are private plans alternative to the traditional Medicare (Government) program.
Medicare (Government) pays the Medicare Advantage plan a fee every month to administer your Medicare Part A and B benefits. In order for you to keep your Medicare Advantage plan you must must continue enrolled in both Medicare Part A and B. This means you have to continue paying for your Part B premium each month.
In Nevada, some plans have $0 co-pays for Primary Doctors and low co-pays for Specialists. Some co-pays may come in for diagnostic imaging, hospital stay, and surgeries.
Most Medicare Advantage plans have HMO or PPO networks.
People who enroll in Advantage plans for Medicare are agreeing, for the rest of the calendar year, to be covered by the plan instead of Original Medicare (Government). You will no longer need your Red, White and Blue Medicare card when you receive care. The only card you will need is your Medicare Advantage plan member ID card. This goes the same for your prescription drugs if you have a Medicare Advantage Prescription Drug plan. You get one card that you present for everything.
Some people don’t realize this and join Medicare Advantage plans without the help of an agent. Therefore they don’t know about all of these rules. Sometimes they find themselves enrolled into a plan that their doctor doesn’t accept or that doesn’t include one of their medications. This happens most often in January after a person has used the Annual Election Period to join a Medicare Advantage plan.
For this reason, Congress designed the Medicare Advantage Disenrollment Period (MADP). The MADP runs from January 1st – February 14th each year. During this time, you can disenroll from any Medicare Advantage plan and return to Original Medicare.
Unfortunately, this does not guarantee that you can return to the Medicare Supplement plan you had before. Unless this was your first time ever in a Medicare Advantage plan, then you will usually have to answer health questions and go through medical underwriting to get re-approved for Medicare Supplement plan. Consider this before dropping any Medicare Supplement plan to go to Medicare Advantage.
Some reasons why people might choose an Advantage plan are:
Original Medicare (Government) with a Supplement plan gives you very comprehensive coverage. The primary differences are that with Supplement plans, you can see any doctor that accepts Medicare. You don’t have to ask your doctors if they take your specific Supplement insurance company. The network is Medicare (Government), which has over 800,000 providers. The network is nationwide, not local to Nevada.
Medicare pays 80% and your Supplement plan 20%, leaving you with little out of pocket.
Supplement plans also don’t change their benefits from year to year. This means they don’t require as much homework from you. You won’t have to annually review the upcoming benefit changes like you will on an Advantage plan.
However, Supplement plans do not include Part D coverage (prescription Drug Plan), so you will need to buy a separate Part D policy. They also do not offer any routine dental, vision or hearing while some Medicare Advantage plans includes these benefits.