Questions? Give us a call
What is a Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is a plan provided by private insurance companies with the help from subsidies provided by the government so that the insurance company can design network-based plans at a low or zero premium.
You must be enrolled in Medicare Part A and Part B while enrolled in a Medicare Advantage plan. Medicare pays the insurance company, on your behalf, to administer your claims and take on your medical risk. When using the plan you show the doctor or provider your Medicare Advantage card, not your red, white, and blue Medicare card. The provider then bills the insurance company instead of Original Medicare.
These plans are normally designed with copays and coinsurance throughout the plans as a form of cost-share that the client would assume when joining one of these plans. Most plans will include additional benefits at no additional cost to you such as dental, vision, and/or hearing benefits as an example.
So let's take a closer look at Medicare Advantage Plans.
Medicare Advantage Upside:
Medicare Advantage Down Side:
1. You are still enrolled in the Medicare Program.
2. You still have Medicare rights and protections.
3. You still get complete Part A and Part B coverage through the plan. Some plans offer extra benefits that Original Medicare does not cover – like vision, hearing, or dental.
4. Your out-of-pocket costs generally will be lower in a Medicare Advantage Plan than in Original Medicare.
5. You cannot buy (and do not need) a Medigap at the same time.
6. You can only join a plan at certain times during the year unless you meet certain Special Enrollment qualifications.
7. You can join a Medicare Advantage Plan even if you have a pre-existing condition.
8. You can check with the plan before you get a service to find out if it is covered and what your costs may be.
9. If in an HMO plan your Primary Care Physician (PCP) is generally your gatekeeper if you need referrals or a second opinion.
10. Go to a doctor, other health care provider, facility, or supplier that belongs to the plan's network, so your services are covered, and your costs are less.
11. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year.
12. Your provider leaving the network does not trigger an enrollment period for you to choose a new plan. If this happens, you may need to choose a new provider.
13. Medicare Advantage Plans can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
14. Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you will pay nothing for covered services. Each plan can have a different limit, and the limit can change each year.
15. If the plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare.
What kind of plans can I choose from?
This eBook will guide you on a thorough side-by-side comparison of Medigap plans (Medicare Supplements) vs Medicare Advantage plans. The eBook outlines pros and cons of both plans and really makes you consider which option is best for your needs.
Safeguard Insurance, LLC
Copyright 2022 -- All Rights Reserved
Insuring your health, life, and retirement.
Phone: 270-904-6070
Email: education@safeguardky.com
1600 Scottsville Rd, Suite 100
Bowling Green, KY 42104
The information presented on this website is for informational or illustrative purposes only. Safeguard Insurance is operated by licensed insurance agents who can help you enroll in an insurance policy. Safeguard Insurance, and any agents or employees, are not affiliated with or endorsed by the United States government, Medicare, or the Social Security Administration. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options. When you request to be contacted about Medicare Advantage, Medicare Part D, or Medicare Supplement plans, you acknowledge that a licensed insurance agent may contact you by phone, email, mail, or in-person to offer additional assistance or to discuss all your Medicare health insurance options.
Safeguard Insurance provides content (via blog posts, YouTube videos, podcasts, eBooks, and any other manner) as a service to its readers. Safeguard Insurance does not offer legal or tax advice. Safeguard Insurance cannot guarantee the accuracy or suitability of our content for a particular purpose without a full and thorough fact finder. We are not responsible for any actions taken by users.