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What is the Advantage of a Medicare Advantage Plan?

Updated: Sep 4, 2020

Have you seen the television commercial featuring a former football star? It airs often, especially between October 1 and March 31. When he announces the list of all the services you can receive, he is referring to a Medicare Advantage Plan. He is correct, all those services are probably available somewhere in the Plans that may be available to you. It is unlikely that you will find all of those services in one Plan.

Medicare Advantage Plans, like Supplement Plans, have more than one name. They are occasionally referred to as Part C, or MAPD, or MA Plans. Remember Part A is premium free for most of us. We paid for this during our working life. It helps cover the cost of hospitalization. Part B covers approximately 80% of doctor fees and numerous other expenses, including some prescriptions and partial hospitalization. Part C is the Medicare Advantage Plan. It is an alternative to Original Medicare, Parts A & B. An important point to keep in mind is, like a Supplement, you must continue to pay the premium for Part B and Part A (if you did not pay for it during your work years).

So, what is the "advantage" of an Advantage Plan? First, many Advantage Plans do not have a monthly premium. You pay Plan deductibles and co-insurance, as you use the services. Additionally, most Advantage Plans also include coverage for your drugs (Part D). Check the Plan's formulary (prescription drug list) to make sure it includes the prescription drugs that you use. Perhaps the most significant benefit of an Advantage Plan is the cap on your annual out-of-pocket expenses, excluding drug coverage. If you decide to use Original Medicare, Parts A & B, you will be responsible for the remaining expenses, no matter how large they are! An Advantage Plan places a limit on your share of those expenses. We refer to the cap as a MOOP, Maximum Out-Of-Pocket. Different Plans have different MOOPs.

Advantage Plans are required to cover everything that Original Medicare covers and they may have additional benefits that celebrities and sports heroes tantalize us with every year!

Many Advantage Plans maintain a network for providers. Costs to you are typically lower if you stay in the network. Some, not all, plans have out-of-network costs. Check the specifics on the plan(s) you are considering. Your best friend's plan isn't necessarily the best one for you.



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