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
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#Understanding Medicare Advantage Plans (PDF) #12026
- 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
When to Apply?
Enroll ONLINE for Medicare Part A Hospital & B Doctor Visits
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
- Instant quotes & #Enrollment for Individual & Family
- Get the latest and most updated information.
- Medicare information contact us [email protected]
- 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
https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final
https://www.kiplinger.com/retirement/medicare/medicare-changes-coming-in-2026
https://ritterim.com/blog/the-2026-medicare-part-d-redesign-updates-agents-should-know/
https://www.youtube.com/unitedhealthcare
https://www.insurancebusinessmag.com/us/news/life-insurance/us-doj-asks-court-to-reject-report-as-unitedhealth-accused-of-improperly-obtaining-billions-531174.aspx
https://theconversation.com/medicare-advantage-is-covering-more-and-more-americans-some-because-they-dont-get-to-choose-251796
https://insurancenewsnet.com/innarticle/medicare-advantage-marketing-driving-up-costs-fiduciary-role-recommended
https://www.chcf.org/publication/2024-chcf-california-health-policy-survey/
https://www.benefitspro.com/2024/11/05/unhappy-medicare-plan-issuers-zero-out-agent-commissions-412-177517/?slreturn=20241112191708
https://kffhealthnews.org/morning-breakout/insurers-brace-for-expected-medicare-advantage-losses-next-year/
https://insurancenewsnet.com/innarticle/what-medicare-clients-are-asking-during-open-enrollment
https://www.medicalnewstoday.com/articles/medicare-give-back-benefit
https://health.wusf.usf.edu/health-news-florida/2024-12-03/taxpayers-spend-22-more-per-patient-to-support-medicare-advantage
https://www.benefitspro.com/2024/11/05/unhappy-medicare-plan-issuers-zero-out-agent-commissions-412-177517/?slreturn=20241231100554
https://www.beckerspayer.com/payer/medicare-advantage-extras-on-the-chopping-block-in-2025.html
https://www.marketwatch.com/story/medicare-advantage-could-get-up-to-1-6-trillion-more-than-its-entitled-to-over-the-next-decade-and-that-could-hurt-the-medicare-trust-fund-study-21d739f4
https://www.fiercehealthcare.com/payers/easy-methods-curtailing-medicare-advantage-costs-can-be-enacted-quickly-experts
https://www.bnnbloomberg.ca/health-insurers-face-3-billion-medicare-clawback-threat-1.1874136
https://healthpayerintelligence.com/news/medicare-pays-medicare-advantage-plans-6-more-than-ffs-medicare
https://khn.org/morning-breakout/medicare-advantage-insurers-boosting-marketing-efforts/
https://healthpayerintelligence.com/news/report-urges-cms-to-increase-oversight-of-medicare-advantage-marketing
https://khn.org/morning-breakout/misleading-ads-driving-people-to-sign-up-for-medicare-advantage-plans/
https://insurancenewsnet.com/oarticle/senior-livingadvantage-plans-offer-leeway-with-nursing-home-care-3
Exercise caution with zero-premium Medicare Advantage plans
https://www.fiercehealthcare.com/payers/medpac-explores-standardized-plan-options-medicare-advantage
https://www.beckerspayer.com/payer/payers-with-the-most-medicare-advantage-enrollees.html
https://revcycleintelligence.com/news/when-cutting-healthcare-spending-ma-pulls-ahead-of-medicare-acos
https://www.kff.org/medicare/press-release/medicare-advantage-is-close-to-becoming-the-predominant-way-that-medicare-beneficiaries-get-their-health-coverage-and-care/
https://www.bettermedicarealliance.org/
https://www.healthaffairs.org/content/forefront/filling-gaps-role-and-value-supplemental-benefits-medicare-advantage
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.