Medicare Blog

how the medicare advantage program is intended to benefit consumers, insurers, and the government.

by Lizeth Bashirian Published 1 year ago Updated 1 year ago

In a Medicare Advantage plan, a Medicare beneficiary pays the Medicare monthly premium to the federal government, but receives coverage via a private insurance company for inpatient hospital ("Part A") and outpatient ("Part B") services. Typically, the plan also includes prescription drug ("Part D") coverage.

Medicare Advantage is designed to provide managed health care for consumers. The structure of the program, including establishing provide networks, enables plans to provide care in the most appropriate setting, with network adequacy requirements to improve health outcomes, while preventing avoidable health care costs.

Full Answer

What is a Medicare Advantage plan?

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.

What is the difference between Original Medicare and advantage?

Medicare Advantage is an all-in-one managed care plan, typically an HMO or PPO. Advantage plans provide the benefits of Part A and B, and most also include Part D, or prescription drug coverage. Some offer extra benefits not available through Original Medicare, such as fitness classes or vision and dental care.

Is enrollment in Medicare Advantage plans increasing?

Enrollment in Advantage plans has more than doubled over the last decade, and half of Medicare beneficiaries are expected to choose a private insurer over the traditional government program in the next few years.

Should I choose a Medicare Advantage or Medigap plan?

In most states, you are only guaranteed access to a Medigap plan when you first enroll in Medicare, as we explain below. With Medigap, you’ll pay more in monthly premiums compared with Advantage plans (see chart below). You’ll also have a bit more work choosing your Part D plan. For many older Americans, Medicare Advantage plans can work well.

What was the purpose of offering Medicare Advantage?

A Medigap policy is private insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn't cover (like copayments, coinsurance, and deductibles).

Why do insurance companies like Medicare Advantage plans?

Two features of Advantage plans make them easy to advertise: the additional benefits and monthly premiums as low as zero dollars in some counties. Original Medicare doesn't include dental, vision or hearing coverage, whereas Advantage plans often do.

Are there advantages to a Medicare Advantage Plan?

Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings. There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling.

What is Medicare Advantage in simple terms?

Medicare Advantage is a type of Medicare health plan offered by private companies that are Medicare-approved. They are considered an alternative to Original Medicare and cover all the expenses incurred under Medicare. They include the same Part A hospital and Part B medical coverage, but not hospice care.

What is the difference between Medicare and Medicare Advantage plans?

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Plans may have lower out-of- pocket costs than Original Medicare. In many cases, you'll need to use doctors who are in the plan's network.

Which of the following defines a Medicare Advantage plan?

Which of the following defines a Medicare Advantage (MA) Plan? MA Plans are health plan options approved by Medicare and offered by private insurance companies.

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

What is the most popular Medicare Advantage plan?

AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.

Is Medicare Advantage more expensive than Medicare?

Slightly more than half of all Medicare Advantage enrollees would incur higher costs than beneficiaries in traditional Medicare with no supplemental coverage for a 6-day hospital stay, though cost are generally lower in Medicare Advantage for shorter stays.

What is another name for Medicare Advantage?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

What are the different types of Medicare Advantage plans?

Most Medicare beneficiaries who get an Advantage plan enroll in one of two types: HMO (health maintenance organization) plans. PPO (preferred provider organization) plans.

Is Medicare Advantage Part of the Affordable care Act?

The ACA does not eliminate Medicare Advantage plans or reduce the extra benefits they provide. It is up to each private insurer to decide what extra benefits to offer (they are required to offer all benefits covered by traditional Medicare).

How Medicare Advantage Plans Work

First, it will help to review a few basics. Medicare comes in four parts, with Part A covering inpatient hospital care, and skilled nursing. There’s no premium if you or your spouse have earned at least 40 Social Security credits.

Why Medicare Advantage Plans Can Fall Short

For many older Americans, Medicare Advantage plans can work well. A JAMA study found that Advantage enrollees often receive more preventive care than those in traditional Medicare.

What to Do

Begin researching your options several months before you first sign up for Medicare, or before your open enrollment period, says Julie Carter, senior federal policy associate at the Medicare Rights Center. Start with these steps:

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