Medicare Advantage Plans MAPD
General Information
What are Medicare Advantage Plans?
Medicare Advantage Plans MAPD are also known as Medicare Part C and/or Medicare + Choice. MAPD plans generally include low co-pays, deductibles, an HMO type list of doctors and hospitals. and often include Dental and Part D – Rx Prescriptions with low or no premiums. The main enrollment requirement is that you must have both Part A Hospital and Part B Doctor Visits which runs about $185/month.
If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. In most cases, you’ll need to use health care providers who participate in the plan’s network. Very few if any plans offer out-of network coverage, other than emergencies or urgent care. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
Check out the Official Understanding Medicare Advantage Brochure at the right if you have a full screen monitor or scroll down or click the link to view.
Get Quotes, Full Information and Enroll
Contact Us - Ask Questions - Get More Information
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By submitting the information below , you are agreeing to be contacted by Steve Shorr a Licensed Sales Agent by email, texting or Zoom to discuss Medicare or other Insurance Plans as relevant to your inquiry. This is a solicitation for Insurance
#Understanding Medicare Advantage Plans (PDF) #12026
- Set a Zoom Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form - Please email us [email protected] for the form - That way we can better analyze your situation to give you the answers to your needs and questions.
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- Visit our general webpage on Medicare Advantage for much more detail and information.
Blue Cross Anthem Authorized Broker
- Instant quotes & #Enrollment for Individual & Family
- Employer Small Group Health Proposals - Quotes
- We’re here to help you with any enrollment, selection and service questions you might have. Anthem pays us to help you at no extra charge! Check out the brochures below and on either side.
Blue Shield of California Authorized Agent - Broker
We represent Medicare Plans from UnitedHealthcare®,
When to Apply?
Enroll ONLINE for Medicare Part A Hospital & B Doctor Visits
Latest News on Medicare Advantage Plans
- 2026
- 2026 Dual Special Needs plan (D-SNP) updates website
- Medicare Advantage Flex Cards Do Not Affect Medi-Cal Eligibility CA Health Care Advocates.com
- Medicare Advantage Options for Dual Eligible Beneficiaries dhcs.gov
- Medi Cal D SNP Feasibility Study dhcs.gov pdf
- Kiplinger article medicare changes 2026
- Fact Sheet Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F)
- Do be sure to check your networks, providers and policies at least at each renewal CA Health Care Advocates
- We can help you check your networks. Try googling your doctor or medical group and add “insurance accepted”
- Filling The Gaps: The Role And Value Of Supplemental Benefits In Medicare Advantage
- Medicare Advantage is covering more and more Americans − some because they don’t get to choose The Conversation.com *
- Better Medicare Alliance
- Medicare Advantage Is Close to Becoming the Predominant Way That Medicare Beneficiaries Get Their Health Coverage and Care Kff.org
- Payers with the most Medicare Advantage enrollees
- What Medicare clients are asking during open enrollment
- What is the Medicare Part B Give Back Benefit?
- MedPAC explores standardized plan options in Medicare Advantage
- Exercise caution with zero-premium Medicare Advantage plans
- Medicare Advantage Insurers Boosting Marketing Efforts
- Insurance Companies dropping thousands of Advantage Plans… Learn more
- Negative News
- Medicare Advantage plans telling rehab patients to go home early
- Misleading Ads
- Insurers exit Medicare Advantage plans, leaving seniors scrambling for options
- Report Urges CMS to Increase Oversight of Medicare Advantage Marketing
- Medicare Advantage plans continue to code more diagnoses than fee-for-service Medicare. This trend has worsened over the last five years.
- Medicare Advantage overpayments continue to balloon. Here are ways policymakers could address the problem
- Medicare Advantage marketing driving up costs; fiduciary role recommended
Resources, Video’s & Links
- History & Details of Medicare Advantage Part C since 1997 CMS.Gov
- Medicare Managed Care Manual
- How is Medicare #funded?
Technical Resources
Understanding Medicare Advantage Plans Continued
FAQ’s, Details to cross your eyes
- MAPD Plans look like a great deal, as the “premium” is paid by fee from the Federal Government, on average $2k/year.Kff * MAPD Plans must cover all A & B services Medicare.Gov * generally they also cover Part D Rx.
- That’s why the premium is very low or ZERO!
- Set a Zoom Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form Berwick Needs Assessment Form – We can better prepare for the meeting
- Medicare Advantage (Medicare Part C): An Overview Hi Cap
- HMO – Narrow Networks?
- HI Cap CA Health Care Advocates Fact Sheet
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
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MAPD plans often include Dental & Part D – Rx Prescriptions and often have NO premiums!
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How is that possible?
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The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It’s best to apply when you turn 65 for the supplement plans or advantage plans, as that’s the main “Open Enrollment” period, guaranteed issue for any plan.
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Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
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Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
- If You Have Problems with Your Medicare Advantage Plan
- forbes.com/how-insurers-can-navigate-the-costs-of-medicare-advantage-benefits
- politico.com/medicare-advantage-plans-congress
- Uncle Sam wants you to help stop insurers’ bogus Medicare Advantage sales tactics
- ca health advocates/using-ai-to-deny-care
- Dodging the Medicare Enrollment Deadline Can Be Costly
- Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals and Doctors
- Medicare Advantage is bad for patients and bad for investors
- When Medicare Advantage Plans Terminate Coverage
- Medi-Cal D-SNP Feasibility Study
- No benefits can be shown on this webpage… Strict CMS rules and all. Email us [email protected]
- A@@RP Medicare Advantage among the lowest-rated plans in key senior markets
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Medicare & Medi Cal Capitation to MAPD or HMO Plans
How much does Medicare Pay Medicare Advantage to take care of you?
AI Summary
- Base Rate Calculation: CMS sets a "benchmark" for each county, based on local Original Medicare spending, adjusted for quality.
- Plan Bidding: MA plans submit bids on how much they expect to care for members.
- Payment Determination: The plan receives the lower of its bid or the benchmark rate.
- Risk Adjustment: This base payment is adjusted up or down based on the health and demographics of the specific members enrolled (sicker members mean more payment).
- Quality Bonuses: Plans with higher quality ratings (Star Ratings) can receive bonus payments. [1, 2, 4, 6, 7]
- Geography: Payments differ by county due to local service costs.
- Enrollee Health (Risk): Higher risk scores (sicker patients) lead to higher payments.
- Plan Quality: Better-performing plans get more funding.
- Supplemental Benefits: Payments are adjusted for extra benefits offered (dental, vision). [1, 2, 3, 6, 7]
- Fixed Payment: Medicare gives the plan a set amount per month per member, regardless of how much you use services.
- Incentive for Efficiency: Plans manage your care to keep costs within that fixed payment, potentially offering extra benefits if they save money.
- Varies Widely: The actual dollar amount isn't a simple number but a complex formula, though it's roughly $1,000/month on average, with significant increases projected for 2026. [2, 3, 4, 5, 8, 9]