Medicare Advantage – Part C

Don’t be fooled. Medicare Advantage plans sold by private insurance companies are NOT the same as Medicare Supplement (Medigap) policies.

So what is Medicare Advantage?

The easiest way to think about it is that Medicare Advantage is like a health plan or managed care plan such as an HMO or PPO that you may of had with your employer if they offered group health benefits. You had a network of doctors and hospitals and maybe a small co-pay to see you primary care doctor.

These plans are administered and sold by private insurance companies that are contracted with the federal government. The insurance companies are then paid by the government on a monthly basis based on your enrollment. Each plan must adhere to a standard set of benefits that includes at a minimum Part A and Part B of original Medicare. Most Medicare Advantage plans, but not all, include prescription drug coverage. Additional benefits are often included like dental vision & hearing, health club membership and discount programs.

Medicare Advantage MOOP

Every Medicare Advantage plan has a Maximum Out-of-Pocket (MOOP) limit and this simply means that you’ll never pay more for services than the stated amount on an annual basis. The MOOP maximum for 2017 is $6,700. Once you reach this limit then you pay nothing for services covered under the plan for the rest of the year.

It’s common to see a lower MOOP in HMO Medicare Advantage plans and the average is $3,400. It’s important to remember that your doctor or hospital may not be available to you in an HMO plan and therefor you would either pay full price or have to look for an alternative provider within the Plans network.

Medicare Dental

Medicare Advantage plans often offer additional benefits, and in most cases you will see a Free Dental option. This is not comprehensive dental coverage and you’ll need to look at the benefits closely. It’s OK to have more coverage than whats offered in your MAPD dental benefit. Just reach out to us and we can show you dental plans available in your area.