John Dickey, Medicare Insurance Broker

Isn't Medicare Advantage just private health insurance? What is the difference?

Answer: While it is true that all MAPD plans are "contracts for health insurance" with/through a PRIVATE health insurance carrier, they ostensibly offer many more additional benefits than a private plan and usually, especially in urban areas, have a larger network of member physicians. Also, most MAPD plans have an embedded prescription drug plan that, just as with the medical part of the MAPD, has NO premium (again, especially in larger urban areas). Private plans have a premium.

Here is a list of other differences, especially if that private plan is a Supplemental Medicare

plan(aka a Medi-Gap policy)

All of the following benefits are provided by a Part C Plan with no out-of-pocket expense (many are not provided by any Supplemental or Employer Plan):

1) No monthly premium or deductible in LA County, with the ONLY monthly cost being

to continue paying the Part B premium. Parts A and B alone DO have deductibles and co-

payments.

2) An annual MAXIMUM medical out-of-pocket expense of NO MORE than $800 in La County!

“Original Medicare” (Parts A and B only) has NO maximum out-of-pocket expense!

3) Virtually NO out-of-pocket expenses (such as co-payments); and, where there are,

they are VERY minimal! (such as $90 WORLD-WIDE for a hospital ER visit, waived if admitted)

4) Long-Term Care benefits - either in a Skilled Nursing Facility or at home

5) transportation (unlimited with one plan) to all medical appointments and/or dental or

pharmacy visits

6) Doctor, RN, LVN and/or physical therapists visits to your home, whenever prescribed

7) no monthly cost whatsoever for those on Full Medi-Cal (since Part B premium will

be paid by Medi-cal and there will be no co-payments for medical care and/or Rx drugs)

8) no out-of-pocket costs every time you see ANY in-network doctor, nor for any hospitalization

(of any duration), or for any surgery (in hospital or outpatient)

9) home health care (possibly including 3 free meals/day)