Medicare Advantage is a fast-growing form of private Medicare plan that offers all-in-one medical and drug coverage. About 25 percent of Medicare enrollees opt for an Advantage plan. Most Medicare Advantage plans are managed care programs, such as HMOs or PPOs. Some private fee-for-service and specialty plans are offered, although the ACA requires all Advantage plans to create provider networks.
When you join an Advantage plan, Medicare provides a fixed payment to the plan to cover your Medicare Part A (hospital) and Medicare Part B (medical insurance) coverage. There are usually additional copayments and deductibles, depending on the type of plan you join.
Shopping for a Medicare D prescription drug plan? Check out my shopping guide here.
Advantage plans are required to use any savings they achieve between the government payments they receive and their costs to either reduce premiums or improve the benefi ts they offer. The plans also can offer-and charge for-supplemental benefi ts such as vision, hearing, and dental care.
Shopping for Medicare Advantage plans
Medicare Advantage plans are offered at the state level, so you need to compare what’s available in your area. Enrollment for Medicare Advantage is done during the annual Medicare enrollment season; for 2012, the enrollment period moves up a few weeks, and will run from October 15 to December 7.
You’re free to make as many changes as you want before Dec. 7; your changes take effect on Jan. 1. There’s also a dis-enrollment period that runs from Jan. 1 to Feb. 14, which can be used by seniors who pick an Advantage plan but want to change their minds. During that period, you can switch back to traditional Medicare but not to a different Advantage plan. And, if you do leave Advantage, you can add a stand-alone drug plan during that period.
Critics of the Affordable Care Act (ACA) have predicted that the new law’s provisions will send Advantage premiums through the roof and decimate plan offerings, but there’s no evidence of that yet. The Medicare Advantage plan market will be stable in 2014; Avalere Health says monthly premiums will be up 5 percent on average, with translates to just $1.64. If you like the plan you’re using, check to make sure there won’t be changes to premiums, deductibles and co-pays, or covered procedures, tests or medical facilities.
Some seniors will have to shift plans, because 142 plans will be discontinued across the country – a 5.3 percent decrease. But the changes won’t be even across all parts of the country. Choices will be abundant in urban and suburban areas, but may decrease in some rural areas.
Advantage plans aren’t permitted to charge cost-sharing, such as co-insurances, co-pays, or deductibles, for certain preventive services that don’t have cost-sharing under traditional Medicare. These include the program’s initial preventive-care visit, annual wellness visits, and screening procedures.
Although an Advantage plan will save money for some seniors, it’s important to review the plan’s network of doctors to make sure yours are in the plan. Also pay close attention to the plan’s co-pays, co-insurance, and deductibles for in-network and out-of-network care. Pay particular attention to the drug coverage offered by Advantage plans. Because Advantage plans are responsible for all aspects of a patient’s care, some offer enhanced drug coverage that might help save them money elsewhere. “Some will cover more over-the-counter medications or preventive drug therapies,” says Mendelson.
Comparing Medicare Advantage options
The Medicare website offers an online tool that lets you compare traditional Medicare with Advantage, Medigap and Part D plans. Click here to access the Medicare comparison tool.
You can also get free counseling and assistance in selecting supplemental plans from your local State Health Insurance Assistance Program (SHIP), a government-sponsored counseling service for Medicare beneficiaries. Click here to find your local SHIP.
Official Medicare Handbook. Each year, Medicare beneficiaries receive “Medicare and You,” a very useful, comprehensive handbook on the program that is published by the Centers for Medicare and Medicaid. Click here to download the Medicare handbook as a pdf document.