Skip to main content

 888-968-9168  wellness@theparticipanteffect.com
  •  
  •  
  •  

  • Home
  • About
    • What Is The Participant Effect?
    • Why is this important to me?
  • Process
  • The Road to Retirement 
    • Getting Started
    • Financial Pathways
    • Investing Wisely
    • Career Changes
  • Resources 
    • Our Blogs
  • Contact

    You are here

  1. Home
  2. Blogs
  3. What Is Medicare Advantage?

What Is Medicare Advantage?

Submitted by The Participant Effect on August 4th, 2020

Medicare Advantage plans, often called Medicare Part C, are sold and administered by private companies. Medicare pays these companies a fixed fee for each enrollee, and they’re required to provide at least as much coverage as Original Medicare (Parts A and B.) Some plans even offer customer rebates.

There are four primary types of Medicare Advantage plans: Health Maintenance Organization (HMO) Plans; Preferred Provider Organization (PPO) Plans; Private Fee-for-Service (PFFS) Plans; and Special Needs Plans (SNPs). HMOs and PPOs are the most common. There’s also a Medical Savings Account (MSA) option, which is similar to a Health Savings Account. You can find more information about the four primary types of Advantage plans at: https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-p...

Some Advantage plans have features that expand on Original Medicare with additions like dental and vision services, for example and can offer cost savings. However, there are also drawbacks, and those mostly pertain to the issues of choice and flexibility. 

With Original Medicare, you can use any doctor or hospital that accepts Medicare, and you won’t need a referral to see a specialist. HMO Advantage plans contract with specific doctors and hospitals to provide services to their members. In most cases, you’ll need to stay “in network” to get the maximum plan benefit. These plans also often need a referral before you can see a specialist. While Medicare doesn’t require pre-authorization for covered services or medically necessary equipment, many Advantage plans do. Note that there are some plans that offer a greater choice of providers, although you may pay more to go out of network. 

You’ll need to balance the cost and features of the plans you’re considering before making a choice. Also note that if you’re a member of an Advantage plan, you can’t also have a supplemental, or Medigap, policy. Medigap policies that extend the traditional coverage of Parts A and B are available with a wide variety of features. And if you want to switch from Medicare Advantage back to Original Medicare, you may be required to undergo medical underwriting, which could affect the availability and cost of certain Medicare supplements. 

Like other kinds of private health insurance, Medicare Advantage plans have lists of approved drugs, or formulary, that they’ll pay for. If you need an uncommon or very expensive medication, make sure the plan you’re considering includes it in their formulary. If not, you may be able to buy a separate Part D drug coverage plan that does. 

Not all Advantage plans are available in all areas. To find a policy where you live, you can go to www.Medicare.gov/plan-compare and search by ZIP code. Some organizations, including American Association of Retired Persons (AARP), partner with insurance companies to provide Advantage plans and have their own comparison tools. 

As you might imagine, there are rules about when and how to enroll in an Advantage plan. A helpful guide can be found at https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan. If you’ve already signed up for Medicare and have a Medicare number, create an online account at Medicare.gov. It will show you what coverage you already have and what other plans – Part D, Medigap, Advantage — you’re enrolled in. 

For advice on how to best navigate the Medicare system to get the coverage you need without overpaying start by talking with your financial advisor. Think about what kinds of medical support you’ll likely need in retirement, and then look for ways to get the care and options you want at the lowest cost. For detailed information and advice, there are also healthcare navigators who specialize in Medicare.


Sources:
https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage...
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-p...

Tags:
  • health
  • medicare
  • retirement
  • retirement planning

money

money

 

 

fb1.pnglinkedin1.pngtwitter1.pngtwitter1.png

Latest Blog Posts

I’ve Depleted My Emergency Fund. Now What?

Submitted by The Participant Effect on February 4th, 2021

Perhaps you’ve lost a job, faced an illness or have been delt a family crisis that emptied out your emergency fund. What are your next steps?

 

Tags:
  • budget
  • emergency fund
  • Read more

How Much House Can I Afford?

Submitted by The Participant Effect on February 4th, 2021

You’re eyeing center-hall colonials in your neighborhood and dreaming about the garden you want to plant in the backyard and all the holiday celebrations you’ll host. You’ve saved toward this goal and think you’re ready to pull the trigger. But the real question is: How much house can I afford?

Or is it?

Tags:
  • budget
  • buying a home
  • Read more

Is Social Security “Going Broke”?

Submitted by The Participant Effect on September 30th, 2020

Social Security’s financial cliff is coming closer into view. Experts project that the fund that pays for government retirement benefits through FICA taxes will be depleted within the next 15 years.

 

Tags:
  • retirement
  • retirement planning
  • social security
  • Read more

Additional info

  • Sitemap
  • Legal, privacy, copyright and trademark information

Contact info

  •   1060 Maitland Center Commons, Suite 360, Maitland, FL 32751
  •   888-968-9168
  •   wellness@theparticipanteffect.com

Contact us

Investment advisory services may be offered through NFP Retirement, Inc. or its subsidiary Fiduciary First, LLC, affiliated companies of NFP Corp. (NFP).

© 2022 The Participant Effect. All rights reserved.

Website Design For Financial Services Professionals