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Medicare Advantage Explained


Medicare Advantage Plans look similar to the insurance you had through an employer and are usually offered as HMOs or PPOs. These plans have a set co-pay at your doctor and ER, along with coverage for the hospital, preventive care, and prescription drugs. These plans offer comprehensive coverage (combining your Medicare A, B, and prescription drug benefits into one plan and ID card) that is provided by a private insurance company, like Essence, GHP/Coventry, United Health Care, or Medicare Complete.

These private insurance companies are paid a fee by the Federal Government to “manage” your Medicare benefits for you. Because these private insurance companies receive funding by our Government, many of them do not charge you any additional premium, besides the current Medicare Part B premium ($134/month for most people). Some companies charge an additional premium above the Part B amount.

When you enroll in a Medicare Advantage Plan, the company becomes your primary insurance. This policy “replaces” Original Medicare. It does not supplement Medicare. Because of this, you typically have to pay the 20% coinsurance for Part B services like MRIs, Outpatient Surgery, Chemotherapy, and other expenses up to a certain amount each year.

Medicare Advantage Requirements

In exchange for a low monthly premium, Medicare Advantage Plans have certain requirements and rules that must be followed in order to ensure compliance and tend to be the biggest frustrations:

  • Network restrictions, including hospital and doctor limitations.
  • Prior authorization from the insurance company first for different services (MRI, hospital stay, etc.).
  • Referrals from your Primary Care Physician in order to see specialists.

A Medicare Advantage Plan may make sense for you if you think that a Medicare supplement and stand-alone Prescription Drug Plan may be too expensive for your budget.

How do you pick the best Medicare Advantage plan?

Consider these things:

  • Each plan has a different list of doctors that participate in the plan.
  • Each plan has different hospitals that are in the plan.
  • Each plan has different prescription drugs that they cover.

What we will do for you is take your specific information (your doctors, preferred hospitals, and prescriptions) and find the plans that “fit” your needs the best. We find this is the best way to choose a Medicare Advantage Plan and eliminate surprises. For example, if you prefer the Barnes Jewish Hospitals, only certain Medicare Advantage Plans have contracts with that hospital.

Get a Free Medicare Assessment Today

Ready for a free, no obligation evaluation of your situation and the Medicare Advantage Plans that may fit your needs the best? Give us a call, 636-561-5060 or fill in the form below to begin the process.

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