Medicare Advantage – 5 Things To Know About Advantage Plans Before You Enroll

Call (888) 310-0376 to Compare All Medicare Advantage Plans in Your State. Get Instant Access I explain 5 things you should know about Medicare Advantage before you enroll. It doesn't make sense to even compare Medicare Advantage plans until you know how it works, who is eligible and when you can enroll in a plan.

As a senior health insurance option, Advantage plans seem to be shrouded in confusion. One reason is because unlike Medicare supplemental insurance, plans are not standardized which makes shopping for a plan more difficult.

If you would like to get the facts about Medicare Advantage vs Medicare supplement insurance, check out my Free 8 Part Video Mini-Course on Medicare Plans.

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The first thing you need to know is that an Advantage plan is not a Medicare supplement. So what is Medicare Advantage? The Medicare and You Handbook states that it is a Medicare health plan like a PPO or HMO and is sometimes referred to as Part C.

Plans are offered by Private insurance companies and you are still enrolled in Medicare. You will receive all Part A and Part B benefits from the Medicare Advantage Plan and drug coverage is often included.

The second thing you should know is how plans work. And that begins with knowing whether or not you are eligible to enroll in a plan. To be eligible, you must:

Have Medicare Parts A and B
Live in the plan's service area
Not have end-stage renal disease

All Advantage plans have premiums if it is $0 per month. Plans shouldn't be referred to as a free Medicare Advantage plan. Premiums are normally lower than premiums for Medicare supplements.

There are 6 types of Advantage plans and you will normally be subject to a provider network. It is paramount to be certain your providers are included. Check for your preferred specialists, ancillary facilities and hospitals in addition to your primary provider.

If you are enrolling in a plan with drug coverage, be sure all your drugs are included in the plan's formulary.

Many people search for Medicare health plans that include extra benefits and are often disappointed when they find Medicare supplements to be lacking. Medicare Advantage plans often include extra benefits not found in original Medicare. They may include:

Silver Sneakers Gym membership
Transportation to and from medical appointments

Third. You need to be aware of when you can pursue Medicare Advantage enrollment. There are 3 types of enrollment periods.

When you first become eligible you have a 7 month window to submit an application. Next, during the Medicare Advantage Annual Election period you can switch, drop or enroll in a plan. And you may have a Special Enrollment Period available if your circumstances have changed.

The fourth thing you need to understand is Medicare Advantage plans are not standardized. Plans are offered County by County and premiums, provider networks, benefits and cost sharing amounts vary widely between plans.

When you compare Advantage plans there are 3 plan documents that are very important to research and understand.

The Summary of Benefits goes into much greater detail than the enrollment brochure. It lists all plan benefits and what each will require in deductibles, copayments, or coinsurance.

The Provider Directory should be you companion until you locate all your providers or find some you are willing to live with.

The Part D drug formulary should include all your required medications. Enrolling in a Medicare Advantage plan that does not include all your drugs can wipe out any savings you may have had over choosing another type of Medicare health plan.

The fifth thing you need to be aware of is how any cuts to Medicare Advantage will affect you.

Understand that a lot of what you hear is politically motivated talking points designed to instigate fear.

Although given the current political climate future funding for the Medicare Advantage program is tentative at best.

If you feel as though enrolling in an Advantage plan is your best option, you should do it. If there are Medicare Advantage cuts in the future and you lose your plan you may qualify for Guaranteed Issue Rights to buy a supplement, even if you have preexisting conditions.

Also, keep in mind that everyone wants to enroll in the best Medicare Advantage plan. And that will be the one that aligns with your specific set of circumstances.

11 thoughts on “Medicare Advantage – 5 Things To Know About Advantage Plans Before You Enroll

  1. There are several things you should know before you enroll in a Medicare
    Advantage Plan. In addition to knowing what an Advantage Plan is and how it
    works, you should be aware of the enrollment periods; including the Special
    Enrollment Periods. You should also know how to proceed if (and when) their
    are cuts to the Medicare Advantage program.

  2. I’ve watched two of your videos. You speak as though the viewer worked for
    an insurance company. My advice: Pretend you’re speaking to a steelworker
    who is retiring and has to get Medicare. Don’t assume the viewer
    understands your acronyms, terminology, etc. I was a medical claims
    adjuster for 20 years and most included Medicare claims. The average person
    has no idea what we are talking about. They’ll just get angry and blame

    • +Jeff Bazell I agree with your assessment 100%. Mr. Forbes speaks as though
      he is reading from the manual. It can be difficult for people (like me)
      that are not acquainted with the vernacular of insurance speak to decipher
      this information. In my opinion, this is the source of the confusion and
      why additional instruction is needed. Recorded efforts that do not break
      the jargon into more laymen s terms only serves to add to the confusion.

  3. I had a medicare supplement plan that I thought was too expensive,so I
    changed to a advantage plan.I was lead to believe (or misunderstood) that
    if I went out of network I would just have to pay the 20% that Medicare
    does not cover and I was fine with that,but I find out that if I go out of
    network I will be stuck with the whole bill(not cool)

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