Medicare Advantage Plans

Medicare and Associated Health Insurance Options

Medicare Part A & B provides comprehensive health insurance.  Each part has a deductible and

co-pays or coinsurance.  Payment for Medicare insurance is deducted from your social security.

Medicare Supplements

  • Independent company insurance working in conjunction with original Medicare
  • Federally approved plans offering various combinations of coverage
  • Plans are uniform regardless of the company offering it.
  • Policy holders pay premiums. Supplements fill in the gaps of what Medicare does not cover. Additional out of pocket cost depends upon the supplement plan selected

Medicare Advantage Plans

  • Insurance provided by a private company, not original Medicare
  • Plans approved by Medicare but vary between companies
  • Policy holders must verify if their providers accept the insurance company plan
  • The Government will pay the insurance company for each participant on their plan.  This means participants pay lower premiums, and with some plans, no monthly premiums.

Comparison of Medicare, Medicare Supplement Plan F and a Medicare Advantage Plan

Original Medicare 2017 Medicare Supplement Plan F MedicareAdvantage Plan Example

Hospital Care

(Part A)

Days 1 – 60: initial $1,316 deductible (per admission subject to benefit period)

Days 61 – 90: $329/day

Days 61 – 150: $658/day

Days 151+ All Costs

Policy pays Part A deductible and all daily co-payments.

Pays up to an additional 365 days of hospital coverage over the course of a lifetime

$298/day for days 1-7

Emergency room: $85 co-pay

Urgent Care: $70 co-pay

Skilled Nursing Facility

Days 1 – 20: $0

Days 21 – 100:  $164.50/day

Policy pays all additional costs up to day 100.

Days 1 – 20: $15

Days 21 – 100:  $160/day

Doctor visit

(Part B)

$183 annual deductible then 20%

Plan pays Part B $183 annual deductible and 100% of assigned services.

$25 co-pay

$50 co-pay for specialists

Annual Physicals: $0

Diagnostic Tests: $0-$240

X-Rays:  $80 co-pay

Outpatient Surgery: $300

Ambulance:  $275

Individual Maximum Annual Out-of pocket

No limit

No limit

$7,000 / year in-network;

$10,000 / year out-of-network.

(Medical services only)

Prescriptions

Limited

None

Generic $9; Brand $48; Non-preferred $97 for the first $3,700; 5% co-pay after $4,950 out-of-pocket

Monthly Premium

Part B Premium $134.00

Must have Part B for all Medicare Plans

Varies

                $0

 

1. This example does not represent any specific plan. It is intended to show how Medicare Advantage plans work

2. Prescriptions do not count toward an Advantage plan’s Annual Out-of-Pocket Maximum limit.

Comparing Medicare Supplements & Medicare Advantage Plans
Medicare Supplements Medicare Advantage Plans
Who pays the claims Medicare pays the majority of
the claim. Insurance company
pays remainder. You may
share in the cost based on
your plan
Insurance company pays the
claim. You share in the cost
based on your plan’s co-pay.
Networks No networks – you may go to
any provider that accepts
Medicare
Plans have networks. You
may go out-of-network, but
co-payments are higher.1
Plan Benefits Plans are standardized and
benefits do not change
annually.
No plan standardization. Plan
benefits vary and typically
change annually.
Prescription Drugs Cover only Part B drugs Cover Part B drugs and may
include Part D drugs.
Medical Underwriting No medical questions when
first enrolling in Medicare.
Will ask medical questions
when changing plans.2
Only one health question: Do
you have end-stage renal
disease?
Premiums Typically increase annually Most plans have lower
premiums then Medicare
Supplements; some have
been as low as zero.
Premiums may change
annually.

1. In an emergency, you may go to the nearest provider and be responsible for only in-network co-payments

2. Exceptions apply. Please call for details.

Selecting a Medicare Advantage Plan

1. Look at the plan’s co-pays. Low doctor office visit co-pays are nice, but look too at the co-pays for hospitals, diagnostic tests, outpatient surgeries, and any other services you feel you may need. Are the co-pays a percentage of the cost or a fixed dollar amount?

2. What is the plan’s out-of-pocket limit? This is the most you can pay for medical services during the year. Does the plan have both in-network and out-of-network limits, or does it have one limit for all medical charges?

3. Are you doctors and hospitals in the plan’s network?

4. If the plan includes Part D, are your medications in the plan’s formulary? What are the tiers for each drug? What are the co-pays?

5. If you live in another area for an extended time during the year, does the plan have a network in that area?

6. How does the plan’s premium compare to other plans?

7. Does the plan offer any extra benefits, such as vision and dental services or health club memberships?