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Medicare Advantage

Colton Lusk

A deep dive into Medicare Advantage Plans

With all the rage on the TV these days it sounds like Medicare Advantage plans are the only thing anybody ever uses for their health coverage. What is all the hype? What are the “advantages” and are there any disadvantages to going with a “Part C” plan? This and more will be covered in this article!

Medicare Advantage, also known as Part C plans are network based plans that will become your primary insurance. What this means is that you will still have Medicare A and B, (this is a requirement to get onto an advantage plan), however Medicare will no longer be paying any claims for you. You will utilize your Advantage plan at your doctors office, the hospital and the pharmacy. Kind of an all in one option.
What are the “advantages” to advantage plans? The things that are appealing to people who sign up for an advantage plan are that they are typically a more affordable option in terms of premium as compared to having Medicare with a separate Medigap plan, which we will talk about in another article. You should know that you will usually have more copays and coinsurance with a medicare advantage plan vs medicare with a medicare supplement plan- if you have ever had an employer plan you will be used to this, Medicare Advantage works a lot like those plans.

Another thing people like about Medicare Advantage is that they offer benefits that aren’t offered through original Medicare. These could be things like Dental coverage, some vision exams and help paying toward eye glasses and contact lenses, some plans also offer gym memberships, as well as other benefits. Not every plan offers every benefit so you should shop around and find a plan that offers you the benefits that are important to you. 

One note about these extra benefits: a lot of the time they are not comprehensive in what they cover- for instance; you might receive dental coverage but it will not cover major services, or maybe it only covers $750/year- this will get you a cleaning and exam and maybe some fillings but not a lot beyond that. Other plans offer a lot more for their dental, just be aware that they do vary in what they cover. At Southwest Senior Advisors we do our best to thoroughly go over all the benefits for a plan you are looking at and make sure you understand what is covered and what may not be covered. Unfortunately, not all agents you talk to on the phone or even in person will be this thorough, they should be and they are supposed to be, but we have come across too many people that got signed up on a plan with promises of lots of great extra benefits all to find out it wasn’t a good fit for them. If this has happened to you, give us a call and we would love to help you get things straightened out. If you are just trying to get an idea of what you want to sign up for, you can also give us a call! We would love to help you get things set up right from the start.

One thing we try to impress upon everyone we talk to about all kinds of insurance, whether that is Medicare Plans, regular health insurance or even life insurance- there is no perfect insurance! They all have their quirks and we have things we wish were better about our plan even if it is “the best” option for us. On that note, there are things that are less than favorable about Medicare Advantage plans as well. Some things that people don’t like about them is that they are network based. This means that you need to make sure your doctor is in network with the plan that you are looking at, otherwise you may not be able to continue seeing them, or you might have to pay a higher copay to see them. We have software that will allow us to check if your provider is in network with any of the plans that you are looking at. If you are local to us we also work closely with most of the providers in the area to know what plans they accept and make sure to keep you in their office after you sign up for Medicare.

Hopefully this helps you gain a greater understanding of Medicare Advantage. They are great plans, but it is so important to know and understand how they work. They aren’t for everybody and there are plenty of people that we have helped and we did not recommend going with a Medicare Advantage plan. Give us a call and we can help you know if it is a good fit for you. If you are on one now and want to compare it to other plans we can also help with that.