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What is Medicare Advantage?

When you first join Medicare, there are two (2) different programs to pick from to get your standard Medicare Part A and Medicare Part B health benefits.


The first program is called Traditional Medicare or Original Medicare.


With this Traditional or Original Medicare, you will usually also get a supplement plan, also called a Medigap plan, as well as a Medicare Part D drug plan.


On this page we will be covering the second program, and that is called Medicare Advantage or also known as Medicare Part C.


One of the major differences between Original Medicare and Medicare Advantage is that the Medicare Advantage programs are administered by private insurance companies that are approved by Medicare to offer the benefits.


These are insurance companies like Blue Cross Blue Shield, McLaren Health Plan, United Health Care, HAP and Priority Health.


This means that while Medicare Advantage plans are required to offer all the same Part A and Part B benefits, these Medicare Advantage companies and plans negotiate prices with the doctors and hospitals. This is how they determine who you can or cannot see to get your Medicare healthcare benefits.


Therefore, Medicare Advantage plans usually work like HMO’s or PPO’s.


Now, these plans sometimes offer additional benefits to their members, including prescription drug coverage, silver sneaker plans, extra vision or dental coverage.


The catch is that some of these plans advertise as having low, if not no, monthly premiums. But the plans can still have
co-payments, co-insurance as well as max
out-of-pocket limits that can be nearly $9,111, which is the legal limit for 2024.


In our opinion, there are two incredibly important things that you must know about Medicare Advantage plans.

1.  You usually have fewer doctor options under a Medicare Advantage plan. Since Medicare Advantage plans work like HMO’s or PPO’s, you need to confirm that your doctor will accept a Medicare Advantage plan, or confirm exactly how your Medicare Advantage plan works.


Usually, you have fewer doctor options with Medicare Advantage, and this is why we recommend that your first step of making your Medicare decision is to ask your doctors what type of Medicare plans do they accept.


Also, be aware that in most states, if you first join a Medicare Advantage plan, it can be hard, if not impossible, to go back to a Medigap plan later because of insurability rules with supplement plans.


2.  Medicare Advantage plans can charge you higher amounts for services such as chemotherapy and dialysis. I was looking at a plan the other day for a client that required the client to pay 50 percent of his chemotherapy until he hit his max out-of-pocket limit of nearly $9,111.


Please make sure you look at the plan details on the Medicare Advantage plans to understand what you can expect to pay for your healthcare both now, as well as in the future.


With all of this said, Medicare Advantage plans can work for certain people, but make sure it truly fits your healthcare needs before finalizing your decision.

Licensed Agent for Medicare Plans

Agent Information:  Karl J. Ruth Jr.  •  National Producer Number: 7267003  


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