If you want to read the full 128 page Medicare and You Handbook, we won't get in your way.
However, if you would like to get the gist of what really makes Advantage Plans different, well...Hello!
We're going to cut to the chase of what we're gaining and losing with Medicare Advantage plans in a way that takes advantage of 25+ years in the senior market.
We'll cover some of the basics just to get a lay of the land but we'll zoom into the real big decision to make around Advantage plans and finally...how to compare the 10 billion options.
Just the facts, mam!
These are the topics we'll cover:
Let's get started!
Let's set the table first before the big meal.
Medicare works like an 80/20 plan with deductibles build in for hospital and a separate one for doctors.
This means, you need to pay a certain amount up front (deductible) and then you start paying 20% of the remaining bills for the rest of the calendar year (Jan-Dec).
Not too hard so far, right??
Medicare does not cover medication (other than in-patient) so we need to address that as well...especially in today's world.
There are other little "gaps" but really, the deductible and 20% coinsurance (amount you pay) are the big gaps along with medication.
Medicare just loves its technical language so let's give everything it's correct name.
Yes, it's a bit out of order but "Part C" is what we're focusing on here. Let's go there now!
So...we have "traditional" medicare above. Then came "medicare supplements" which fill in the holes to varying degrees.
Then came Advantage plans. Essentially, Advantage plans are new HMO kid on the block!
The goal was to offer coverage to seniors with Medicare at a lower cost than supplements which can run a few $100 per month.
They did that!
As a trade-off, we're agreeing to work within an HMO model.
This generally means:
Some people are very familiar with HMO plans from their pre-65 days. Others will only deal with PPO type plans where there's more flexibility (that's the medicare supplement side of things).
We have a huge comparison of Supplements and Advantage plans.
This is really a key driver of which way to go to address the holes of medicare. We looked at why you definitely want to have some additional protection to stand-alone Medicare.
Of course, we're happy to help you compare your options including Advantage or Supplements!
There's no cost for our assistance and our Google reviews tell the tale!
What about RX and Advantage?
This can be a big difference.
A person with Medicare can buy a stand-alone Part D plan to cover medication.
Many Advantage plans will include RX coverage right in the medical plan!
This can generally save $10-$50/month depending on the Part D plan in question.
As with all HMOs, you'll have more management of the RX benefit with an Advantage plan.
In today's world, that's not necessarily a bad thing where many new brand drugs are slight modifications to existing medications to extend or renew patents.
There may be situations where a new-fangled medication (very very expensive) is not offered with an Advantage plan UNLESS there's no alternative.
Keep in mind that Part D plans will also have some "management" as well so the difference may not be sizable.
You can run your drugs through our Quote System (run quote and it will show you the plans that best cover your existing meds! Make sure to enter that info in this system. Just one more tool we bring to your aid...for free!
Now...let's really roll up our sleeves and cut to the chase with this whole decision!
You're getting dozens of calls (not from us!!!) and then a small birch tree in mailed flyers for Medicare options.
What's the real deal here?
When considering Advantage plans versus supplements, it really comes down to a "shift" in cost.
Everyone's pushing and selling but they're probably not telling you the full story.
We really need to understand the trade-off:
That's the rub. That's where the tire meets the road.
So...how on Earth do we compare this?
First, we have many people coming off of Covered Ca with very low premiums due to tax credits.
It's not even a question.
For many people though, they're "sold" no cost Advantage plans without any explanation of the "back-end".
That's a big red flag. We're not anti-Advantage plan but you really need to understand the trade-off.
Focus on the out-of-pocket max (OOP). That's your worst-case exposure in a calendar year (in-network of course for covered benefits).
It's generally around $1000/year (but can go much higher).
Here's our "Triple Threat" which we describe in our How to Compare Advantage Plans:
So...let's take a hypothetical example at age 65.
If we're in good health, the Advantage plan will work out great. We're saving about $1400/year (let's say $1000 assuming some minor health care costs).
What if we have something bigger?
Okay...now the real out of pocket is $1000 (OOP max is hit). Still not bad so the consideration is more on the network (who we can see and what health care will be allowed by the HMO) and control of care.
Let's say we have a $2000 max out of pocket and we have bigger bills.
Now, the "real" monthly premium equivalent is around $180/month!
Again, everyone's situation is different but just understand the trade-off between paying now (monthly premium) with supplements or lower OOP advantage plans and paying later (copays and cost sharing) with the Advantage plans everyone's pushing.
So...how on earth do we compare all the different "flavors" of plans out there?
A few broad strokes to help you on your way:
First, you can run your quotes here with tailored options according to doctors and/or medications! It's really pretty fantastic.
Let's hit the highlights and you can always reach out with any questions. There's no cost for our assistance as licensed Medicare Advantage agents.
Since we're comparing against Medicare supplements at around $1500/annually, we would hope to cap our exposure under that amount or we're rolling the dice we'll be healthy.
So...aim for a max-out-of-pocket around $1000/year. This "savings" even in a bad year makes up for the more restrictive network/care considerations with Advantage plans.
There's a lot of slinging gym memberships and vision benefits while forgetting to mention the $3000 out of pocket max.
Again, we're happy to walk through this with you since there are so many options!
Next up...(maybe first up??)...networks.
If there are doctors/hospitals you want access to, best to check what plans they participate with first.
Our system will automatically do this for you here!
You may find that a trade-off needs to be made..."I can have these two doctors but not this one".
That's a function of Advantage plans but in many areas (especially more populous ones), we can find plans that work with most and even all doctors.
We have a massive Comparison of Advantage plans with actual examples.
Hospitals also figure in so make sure to enter those as well or check with us!
Keep in mind that there's geographic constraint on doctors and medical groups. Usually around 45 miles depending on the area (and density).
Kaiser is a totally separate beast. If you want doctors outside of Kaiser, you would run your quote here.
What about medication?
Almost all Advantage plans include a medication benefit or Part D plan build in. This makes it easier but also adds one more "layer" of requirement when comparing Advantage plans.
We make this easy!
Just enter your medications along with your doctors and our quoting system will automatically generate the plans that participate and cover your meds.
The pharmacies are all pretty easy since 90% of them work with the big Advantage plans.
It's really about zeroing in on your particular meds.
Finally, how to avoid a lemon.
Though not perfect, the carrier ratings are slowly starting to capture people's actual experience with the various companies offering Advantage plans.
Both good and bad!
We can use this as a benchmark once we determine which plans will work with our doctors and medications.
We have a whole Advantage plan California comparison but the big players Statewide that contract with independent doctor/hospitals are:
There can be regional players and we're happy to help you compare. Our system has access to major plans in a given area.
Here's the issue...the real driver of Advantage plans come down to the networks and as with any HMO, networks come down to carrier size and strength.
Really...the ability of the carrier to negotiate in a given area is based on how many members they have.
That's the raw math of it so the bigger carriers tend to have bigger/better networks and better pricing.
This, after all, is the whole point of the HMO model itself! Manage costs by managing care and this only works with large groups of people!
That's why you don't find great Advantage plans in rural areas (if at all).
Again, we're happy to compare all the strong carriers in your area according to your doctors, hospitals, and medications!
No cost to you. It's what we do (and we do it well). See Google Reviews.
Also, no question is a bad question. Medicare's complicated so we're happy to walk you through it!
Call 800-320-6269 or email us at firstname.lastname@example.org
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact www.medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 day a week to get information on all of your options.