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 $148/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.
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How is zero or low premium coverage possible?
It’s not free, Medicare pays the Plan – Insurance Company about $1,000/month InsureMeKevin * to care for you, which includes paying us as your agent to help you at no charge. Here’s an more Explanation from * Insure Me Kevin.com
See also our webpage comparing Original Medicare, Medi-Gap and Medicare Advantage.
Please email us to discuss your options.
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan. MAPD Plans must cover all A & B services Medicare.Gov *
That's why the premium is very low or ZERO!
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- #Intake Form - We can better prepare for the meeting
- HMO - Narrow Networks?
- 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
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? 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.
Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
Medicare Advantage Plans cover all Medicare Part A and Part B services
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care.
Medicare Advantage Plans must cover all of the services that Original Medicare covers.
However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
Some Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and other health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might have to pay a monthly premium for the Medicare Advantage Plan.
Medicare Advantage Plans must follow Medicare’s rules
Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year. Remember, you have the option each year to keep your current plan, choose a different plan, or switch to Original Medicare. S
Read More in Medicare & You – see side panel or scroll down if you are on a smartphone
When to Apply?
It’s best to apply when you turn 65 or a few months before or after for the Medi Gap – supplement plans or Medicare Advantage Plans, as that’s the main “Open Enrollment” period where coverage is guaranteed issue for any plan.
If you didn’t enroll in Medicare Advantage when you turned 65, you can do that or change plans at the Annual Coordinated Election Period (AEP) which runs from October 15 through December 7 each year.
You can also change prescription drug plans, return to Original Medicare (or must you wait for the disenrollment period?) and look into Medi Gap plans (PPO Any Medicare Provider).
There is a guaranteed right to enroll in Medi-Gap after a one year trial period in MAPD. Your new plan, renewal and enrollment changes are effective on January 1.
For more details and the exact rules, see our page on when can you enroll for more details, or email us.
There is a navigational menu above and below for the Companies, we represent with their brochures, provider lists, etc. that pay us to help you enroll in their plans at NO additional cost to you.
Resources, Video’s & Links
Medicare Made Clear 64 pages from UHC
What is a Medicare Advantage Health Plan Publication 11474
History & Details of Medicare Advantage Part C since 1997 CMS.Gov
My Advocate Helps This website helps you Save money, engage with your community, and improve your health.
What % of those on Medicare, pick a Medicare Advantage Plan? Which companies have what % of the market?
Some thoughts are that Medicare Advantage plans might leave sicker patients in a worse position CA Healthline 7.6.2017
How is Medicare #funded?
What are the different types of Medicare Advantage Plans?
Health Maintenance Organization (HMO) plans:
- Anthem MediBlue Plus
- Blue Shield 65 Plus HMO
- United Health Care
Preferred Provider Organization (PPO)
Private Fee-for-Service (PFFS) plans: See page 63. (I haven’t see these in CA)
- End Stage Renal – Kidney Failure
- Mental Health SNP Special Needs Plan
HMO Point-of-Service (HMO POS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Medical Savings Account (MSA) Plans: (I haven’t seen these in CA) These plans combine a high deductible health plan with a bank account that the plan selects. The plan deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA Plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.
- AARP – Part D Rx
- Blue Cross Rx
- Blue Shield Rx
- Premiums for those with High Income
- Shop & Compare Tools Part D Rx
For more information on MSA Plans, visit Medicare.gov. To find out if an MSA Plan is available in your area, visit Medicare.gov/find-a-plan. or find a qualified agent in your area.
If you are in CA, that’s Us!
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NEW Name: Elevance Health
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- Individual & Family Health & Dental Direct ***
- Medi Gap, Part D Rx & Medicare Advantage 2023
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- Steve Video @ Blue Shield of CA Headquarters
Exercise caution with zero-premium Medicare Advantage plans
Can you give me a brief overview of the MA landscape.
Will MAPD in Northern California actually be a decent option in 3-5 years?
Good Question. I don’t have a crystal ball though.
Threats to cut Medicare Check this page… many new features & benefits are coming to Medicare Advantage Plans. That seems to be what Congress wants you to buy.
Here’s some of the changes that Health Care Reform changed to Medicare.
Taxes to Fund Medicare
My Father died last month. My mom needed to go to the hospital over the weekend. Now all of a sudden Kaiser (under my Dad’s Retiree Program from AT & T) is saying that my Mom’s Medicare Advantage plan is cancelled. My Mom was not given any notification of termination. I had to pay cash to get her admitted.
How can a MAPD plan terminate coverage without notification?
IMHO the best way to see the rules on termination would be to look at the actual evidence of coverage EOC. I don’t have yours, so let’s look at this one. CMS sets the rules… so they should be basically the same.
Using the table of contents We see that termination and ending membership is in chapter 10 starting on page 203.
On page 209 – When must the Insurance Company end your plan, I don’t see a spouse passing away as a reason! On page 210 the policy states:
My SWAG guess is that since the primary holder of the policy passed away, they just cancelled the entire policy. CRAZY huh!
Kaiser doesn’t charge for their MAPD plan, so I can’t see any premium issues. There might be issues with the Part B premium as maybe that was paid for under the retiree plan your Dad worked for.
I would need to review the retiree plan documents from your Dad’s employer.