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Medicare Advantage Plans, called Medicare Part C or MA Plans, are becoming increasingly available. More than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage Plan in 2020, and there are even more plans available in 2021 than ever before, according to research by the Kaiser Family Foundation.
Medicare Advantage Plans are an alternative to Original Medicare. Like Original Medicare, Medicare Advantage Plans provide Part A and Part B coverage but MA Plans also often include Part D prescription drug coverage. These plans can also cover things Original Medicare does not cover, such as dental, vision and fitness programs. Some may cover services like transportation to a doctor’s office, over-the-counter medications or wellness services.
“There are also special plans for chronic illnesses that offer expanded benefits to help with the condition,” says John Hill, president of Gateway Retirement in Rock Hill, South Carolina. There are 971 Special Needs Plans (SNPs) available in 2021, a 14% increase from 2020, according to the Kaiser Family Foundation.
There may even be other value added benefits such as meal delivery services after you’ve been hospitalized, says Elizabeth Gavino, founder of Lewin & Gavino, an independent broker and general agent for Medicare plans. “It all depends on the carrier and the offerings in your area.”
Medicare Advantage Plans are offered by private insurance companies that have been approved by Medicare. These companies must abide by the rules set by Medicare. You still have Medicare if you have
“(Medicare Advantage Plans) are reminiscent of plans you may get through your employer as they may have deductibles, copay, and coinsurance, and require you to select providers from a network,” Gavino says. “Some plans may give you access to providers not part of the network.”
Plans can set different rules for how you get care, such as if you need a referral to see a specialist, and these rules can change year by year. MA Plans also charge different out-of-pocket costs with varying annual maxes. The plan costs are set by the private provider, not Medicare, and are set each year. The amount you pay can only change once per year on January 1.
The plan will send you an Annual Notice of Change (ANOC) document each fall notifying you of any changes that will become effective in January. You’ll also receive an Evidence of Coverage (EOC) document provides details about the plan coverage and how much you’ll pay while the Annual Notice of Change
Your costs will depend on things such as if the plan charges a monthly premium. Many plans have $0 or low premiums because they are subsidized by the government, Gavino says. Over half of plans charge no premium in 2021 other than the Part B premium and nine in 10 beneficiaries have access to a no-premium plan, according to the Kaiser Family Foundation.If your plan does charge a premium, you’ll pay it in addition to your Part B premium. Some plans may pay part or all of your Part B premium.
Other factors that can affect your out-of-pocket costs include if the plan has an annual deductible, copayment or coinsurance for services, the type and frequency of the services you need and if you use in-network or out-of-network providers. MA Plans may also charge for the extra benefits provided.
“These plans are available depending on the county you live in,” Gavino says. So some areas may provide benefits that are not available in other parts of the country. You can find the Medicare Advantage Plans available in your area on Medicare.gov.
Medicare Advantage Plans have benefits but also come with downsides. Some of the pros of Medicare Advantage Plans include:
The cons to Medicare Advantage Plans include:
Given the copays and potentially high cost ceilings, Medicare Advantage Plans can be expensive. Are Medicare Advantage Plans worth the costs?
“Yes,” says Gavino, “but you need to be prepared for all of the costs.”
You should also pay careful attention to what medications and health care providers are offered in the plan. You should also consider if the plan offers value added benefits that may be useful to you. These extra benefits can be even more expensive to purchase separately, such as with a Supplement plan.
“When you are in the Supplement option, everything is a la carte,” Hill says. “In the Medicare Advantage Plans, most everything is bundled.”
These experts were consulted for insight into how Medicare Advantage Plans work.
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.
Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.
He’s passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.