What do private Medicare Advantage insurance companies want? Your money of course! How far will they go to get it? Now MA Plans cannot outright lie to you to get your business. But there are a lot of common misconceptions. And these misconceptions often benefit the carriers and the plans.
What is Medicare Advantage?
Medicare Advantage is also known as Part C or Managed Care plans. They replace Original Medicare entirely. So, you cannot have Original Medicare and a Medicare Advantage plan.
They must offer at least the same benefits as Original Medicare but often offer additional benefits as well such as dental, vision ,hearing, and prescription drugs. And no, those benefits are not offered by Original Medicare.
You will often have lower copays or deductibles and Medicare Advantage Plans will offer an out of pocket maximum- something which Original Medicare does not have.
There are also special needs plans such as DSNPS and CSNPS.
Now with MA plans, there are networks that you must operate within a network.
Are They Free?
Are MA plans free? No, they are absolutely not! Many Medicare Advantage plans advertise themselves as free or at no extra charge. However, at the very least you will still need to continue to pay for your Part B coverage. You may notice that in the fine print.
That being said, if MA plans were still really able to deliver on all of the other promises and incentives, they might still be worth it. Let’s talk about some other misconceptions.
PPOs Give you Flexibility But NOT As Much As Original Medicare
MA plans are offered by private carriers. They have HMOs and PPOs.
So, PPOs will give you much more flexibility. This is important because it can be very difficult to find a specialist who accepts many Medicare Advantage plans, although PCPs are much easier to come by.
However, you still have the issue of preauthorization
In a Managed Care Plan, although your doctor may order a special test of procedure, your insurance carrier must first approve it. This is “preauthorization”. Your insurance carrier may deny coverage which could result in delays or enormous bills.
Extra Benefits
Medicare Advantage Plans will often offer additional benefits to entice beneficiaries. Your plan may offer dental, vision, hearing, prescription drugs and more!
However, these benefits purchased separately are often not expensive so it is important not to sacrifice access to quality medical care in favor of these fringe benefits.
Additionally, make sure the extra benefits offered will work for your needs. For example, if your MA plan offers dental coverage, but it only offers a DHMO and you need a PPO, it’s not really applicable to you.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
