Medicare shouldn’t take an advanced degree to understand. But sometimes it seems like that’s exactly what you need to navigate the Medicare system.
It’s worth noting that enrollment in the Medicare Advantage program has increased significantly since its introduction. Since 2010, the number of Advantage enrollees has increased from 24% of Medicare recipients to 32%. That means roughly 17.6 million Americans are enrolled in the Medicare Advantage program.
Here we’ve put together the basics of what you need to know to understand Medicare Advantage, otherwise known as Medicare Part C.
What is Medicare Advantage?
Medicare Advantage – also known as Medicare Part C – is very similar to Medicare Parts A and B. The key difference, however, is that Advantage is provided by private insurers. This gives those Medicare recipients that go with Advantage flexibility in choosing a plan and a provider that is right for them.
The Advantage plan takes over for Medicare and makes all the rules regarding your health care and sets forth cost sharing, such as copays for doctor and specialist visits, impatient hospital care which can usually cost a couple of hundred dollars each day you are hospitalized, X-rays, lab services, outpatient procedures, ER visits, radiology etc.
When choosing an Advantage plan you would obviously want to sit down with a BGA Insurance agent because there are an abundance of plans to choose from and they vary widely regarding monthly premiums, deductibles, cost sharing and network providers. When I say network providers, you want to make sure whatever Advantage plan you settle on, all your doctors accept the plan you choose.
How is it Different Than Medicare Parts A and B?
Other than having a choice in providers, the biggest difference between Medicare parts A and B, and enrolling in Advantage, are the out of pocket spending caps. With part A there are hospital visit deductibles for each hospital event, plus cost-sharing by the patient for lengthy stays. And while the annual deductible is much lower for part B, patients still pay 20% of covered services after the deductible is met, with no cap. This means extensive care could still run into the thousands.
With Advantage, though, recipients do pay co-pays and deductibles, but there is also a cap on out of pocket spending. In 2016, that cap was $5,223.
The one disadvantage of the plan is you can’t use Medigap plans with Advantage. But since Medigap plans can be expensive on their own, this may not be a significant consideration for many people.
Is Medicare Advantage Available in My Area?
If you purchase an Advantage plan, contact your BGA agent regarding a cancer, heart attack and stroke supplement plan to pay for that 20% gap.
Call (855) 494-0097 for help with your plan if you live in New Jersey, Pennsylvania, or Delaware.
Medicare Advantage Five County
IBC Keystone 65 Basic Rx HMO
IBC Keystone 65 Focus Rx HMO
IBC Keystone 65 Select HMO
IBC Personal Choice 65 PPO
Advantra Gold PPO
Advantra One PPO
Advantra Silver HMO
Aetna Medicare Choce Plan HMO
Aetna Medicare Silver Plan HMO
Aetna Medicare Gold Plan PPO
Aetna Medicare Main Line Health Prime Plan HMO
Aetna Medicare Premier Plan HMO (Bucks, Chester, Delaware, Montgomery)
Aetna Medicare Basic Plan HMO (Bucks only)
Aetna Medicare Standard Plan HMO (Bucks, Chester, Delaware, Montgomery)
Aetna Medicare Standard Plan HMO (Philadelphia)
Prescription Plans – Pennsylvania, New Jersey, & Delaware
Envision RxPlus PDP
Aetna Medicare Rx Saver PDP
Aetna Medicare Rx Select PDP
Humana Walmart Rx Plan PDP
Humana Preferred Rx Plan PDP
Humana Enhanced PDP
First Health Part D Value Plus PDP
SilverScript Choice PDP
SilverScript Plus PDP
Cigna Health and Life
Aetna Health and Life
American Retirement Life Insurance Co.
Loyal American Life Insurance Co.
Mutual of Omaha
United Health Care thru AARP
United of Omaha
What are the Costs?
The costs are dependent on the plan you choose and the providers available in your area. However, the cost is very comparable to the cost for Parts A and B. And it’s anticipated that the average Advantage plan cost should drop just over $1 a month in 2017 over the 2016 monthly rates.
When Can I Enroll in Medicare Advantage?
The election period for choosing the Advantage plan is from mid-October to the beginning of December every year. Only during this time period can you enroll in Advantage or change your plan.
Can I Go Back to Original Medicare?
If you find that the Advantage program isn’t for you, there is a disenrollment period. From the beginning of the year to mid-February, you can choose to drop your Advantage plan and return to the Original Medicare plans A and B.
Given the advantages of Medicare Advantage, it’s worth it for most people to investigate the Advantage plans available in their area to see if there is plan that better meets their personal medical situation and needs.
BGA Insurance Group helps seniors choose a Medicare Advantage Plan for 2017 or 2018 in the following states and cities:
- Pennsylvania (Philadelphia area)
- New Jersey
- Conshohocken (office)
- Allentown (office)
- Cherry Hill (office)