Medicare Advantage

Advantage plans, also known as Part C, were created in 2003. People wanted more benefits than were available with Original Medicare A and B, and they wanted more choices for coverage. Now, around 40% of all Medicare clients use Advantage plans. In Colorado we have 9 different companies and each has multiple plans.

Advantage carriers have a contract with Medicare to manage your Parts A and B, and most manage Part D as well. Instead of Original Medicare’s Fee for Service system, you will be dealing with a healthcare company who manages A and B. So put your Medicare card in a safe place as you will be using a single card from the Advantage plan. Medicare reimburses the carrier for your membership. Approximately $600 - $900a month for most plans.

Here are some highlights of Advantage plans:

·         Each plan has a network

·         There are HMOs (Health Maintenance Organization) and PPO’s (Preferred Provider Organization), MSA (Medicare Savings Account) and PFFS (Private Fee for Services)

·         Many plans have a zero premium

·         You can choose a plan with Part D included

·         Extra benefits may include dental, vision, hearing benefits, fitness benefits and over-the-counter merchandise at no charge

·         All plans have a Max Out of Pocket, and it must be $7550 or less.

·        Each plan has co-pays and co-insurance for services

·         The plans are very competitive and seem to get a little better, but not always, from year to year

Each year you have two periods when you can change an Advantage plan. First is Annual Enrollment from October 15-December 7, and the 2nd is Open Enrollment Period from January 1 through March 31. So you are not stuck with one plan. Change is possible with no health questions asked.

Every September the Advantage plans send out an Annual Notice of Change. The reason for this is that the plans are approved for one calendar year, so they change every January 1. If you don’t make a change you will be auto-enrolled in your current plan. So be sure to read the Annual Notice of Change. Make sure your plan is still going to work for you.

The video will help you as you determine what coverage is best.



Now you should have enough solid, basic information to understand how Medicare Advantage plans work. Next, we will look at Medicare Supplements.