Medicare Questions & Answers: Medicare Advantage
Medicare Advantage Q&A
Showing 122 questions
Are Medicare Advantage plans really "free," or is that just clever marketing?
The concept of "free" Medicare Advantage plans can be misleading. While some Medicare Advantage plans advertise $0 monthly premiums, it's crucial to understand that this doesn't mean you won't have any healthcare costs. Here's a breakdown:* $0 Premium Doesn't Mean $0 Cost:
A $0 premium means you don't pay a monthly fee to the private insurance company offering the Medicare Advantage plan. However, you'll still likely have other out-of-pocket costs, such as:
* Co-payments: Fixed amounts you pay for specific services (e.g., doctor's visits, prescriptions).
* Coinsurance: A percentage of the cost you pay for services.
* Deductibles: The amount you pay before your plan starts covering costs.
Is Original Medicare or Medicare Advantage better? Why do you recommend one over the other?
It will be different for everyone.Original Medicare lets you see any doctor that accepts Medicare and pairs well with a Medigap plan to lower out-of-pocket costs, but it doesn’t cover dental, vision, or prescriptions.
Medicare Advantage bundles everything, often with extra benefits like dental and vision, but you have to stick to a network of doctors.
If you want flexibility, Original Medicare with Medigap is usually better. If you prefer an all-in-one plan with lower upfront costs, Medicare Advantage might be the way to go.
My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?
Having good, reliable doctors that you trust is really important. When looking into an Advantage plan, the first thing to consider is if a doctor is "in network". When a doctor is "in network" it means that the plan will cover those visits. If a doctor is "out of network" you will not be covered by the plan. When I meet with a person, I have a system that will narrow down plans that each doctor is covered by so that we can ensure the best coverage and benefits which is unique to each individual.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans do have some great benefits, but some things to keep in mind are:Medicare Advantage plans has specific doctors and hospitals in their network, so these plans are network based.
Prior Authorizations are needed for some services, which can cause some delay in necessary care.
It's important to check each year to make sure your doctor is still in the network, as this can change from year to year.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
The short answer is no. However, there are always exceptions such as a Special Enrollment Period (SEP) to make a change or within your 12-month trial right period, or you are involuntarily terminated from your Medicare Advantage plan due to moving out of the plan service area, gaining eligibility due to age (turning 65), to name a few. In these cases, I want to discuss the change and ensure we cover all available SEP options.
Why do some agents push Medicare Advantage plans over Medigap-should I be skeptical?
There are “captive agents” who work exclusively for only one insurance company. Therefore, they push the Advantage plan since it is the only one for that agent to earn a commission! Thus, what I have said before many times in this column, it is essential to be interviewed by 2-3 different agents, preferably an independent agent who may also be known as “a broker” who is affiliated with a variety of different firms and can tailor his advice to specifically YOU! Don't be afraid to ask the question as to whether she/he is a broker and have the agent name a minimum of five different national insurance firms for whom an application can be written! Remember: there is no “cookie-cutter” plan recommendation for everyone!
Can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones?
You may or may not keep your current doctor's when switching to a Medicare advantage plan. Some HMO's and PPO's have extensive networks and your doctors may all participate. If you decide on an HMO you just stay in network. PPO's allow you to go out of network though your cost may be higher.
What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
An HMO limits your services to a closed network of physicians and caregivers. HMOs require members to choose one of their in-network primary care physicians to manage your healthcare, and require a referral approval to use other in-network services. HMOs generally do not allow any out-of-network services unless it's an emergency.PPOs are more flexible with their network of services and do not necessarily require a primary caregiver. You can use services outside of their network of treatment services, and you will still be covered. However, PPOs generally have higher prices, deductibles, copays, and coinsurance when you use services outside of their network.
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
Medicare Advantage Plans are not FREE. They may have a $0 premium. However, you must continue to pay your Medicare part B premium to qualify for a Medicare Advantage Plan.
I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself.
This on can be tricky.Using an HMO plan typically means you would want to stay within the network in order to keep your costs as low as possible. If you see a doctor outside of the network, you could end up paying the full cost for that care. There could be some exceptions if this was an emergent care issue while out of network. Be careful seeing an out of network doctor on an elective basis.
Some HMO plans are Point of Service (POS). A POS plan may allow you go out of network for some things. If it is a POS plan, you can probably count on paying a higher price if you choose an out of network provider, however.
Call your plan provider and double check before having the services provided. It's really the only way to know for certain what you're facing. Wish you best!
If I move to a rural area, how might that limit my Medicare Advantage plan options?
Moving to a rural area could mean fewer Medicare Advantage plans to pick from, since these areas often have lower enrollment and less competition among providers. You might also face narrower networks, making it tougher to find in-network doctors or specialists without traveling farther. In my experience, some rural spots even lack plans with the extra bells and whistles—like dental or vision—that you’d see more of in heavier populated counties.
My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Original Medicare has deductibles and co-insurance and doesn't include drug coverage-part D (If you don't have a PDP- Prescription Drug Plan-and haven't had one for over 63 days after your initial enrollment period has passed, you'll pay a lifetime penalty when you sign up.) With original Medicare, you can go to any doctor who accepts it.In 2025, part A has a $1,676 deductible. You pay:
Days 1–60: (of each benefit period): $0 after you meet your Part A deductible ($1,676).
Days 61–90: (of each benefit period): $419 each day.
After day 90: (of each benefit period): $838 each day for each lifetime reserve day (up to 60 days over your lifetime).
After you use all of your lifetime reserve days, you pay all costs.
There's a term here, "benefit period". The benefit period lasts for 60 days. If you are out of the hospital for over 60 days, the process starts over, and you pay the deductible again (lifetime reserve days do not start over).
Part B has a $257 deductible, with generally a 20% co-insurance after it's been met. Original Medicare has no maximum out-of-pocket. If you are in the hospital multiple times during the year, the costs can be financially devastating.
Medicare Advantage plans have maximum out-of-pocket limits built into their plans. Depending on where you live, there are both HMOs and PPOs to choose from. HMOs require referrals to see specialists. PPOs are more flexible but costs for out-of-network doctors are higher.
Another option is Medicare Supplement, which works with original Medicare. If you choose this option, you need a stand-alone PDP. Knowing this information should help you decide who to listen to- your children or friends.
Is it better to get Medicare Part D or Medicare Advantage?
So deal with someone like myself here at State Farm on Kelly Street and say, "Hey, this is what I'm looking to do, Tony. Here's my history. Here's my family's health history. Give me some information so that I can make some great decisions." And that's what we do. Please don't take someone else's advice. I hear a lot of, "I asked my friends, I asked my boss, I asked the guys I golf with." Talk with someone like myself who all they do daily is Medicare, Social Security, and retirement planning. Good luck.
I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?
Should I keep original Medicare or go with an Part C, Medicare Advantage plan? What is better?
What is better for one Medicare beneficiary, could be the biggest mistake for you. Unfortunately, there is no 'better' or 'best' when it comes to choosing your Medicare path. It is important that you work with a trusted broker to clarify your options.Original Medicare only should not be a consideration for most people. The financial gaps within Original Medicare will be catastrophic to most people. However, Original Medicare + a Medicare Supplement plan is what you will want to compare to a Medicare Advantage Plan.
Most of our Medicare clients come down to the conclusion that it's Freedom VS Cost. The Medicare Supplement provides freedom of choice for a Medicare beneficiary, but typically at a higher monthly cost. The Medicare Advantage plan often has a $0 monthly premium for the plan itself, but you are often bargaining with some of your freedom of choice, such as what doctors you can see.
Regarding the cost of a Medicare Supplement or Medicare Advantage plan, we are referencing what Medicare Supplements & Medicare Advantage plans cost in the state of Florida, as costs can vary across the USA.
How do you explain to clients that "zero-premium" doesn't mean "zero-cost" with Medicare Advantage?
Benefits vary from plan to plan. Often times you may have a $0 copay with an in-network primary care physician, for example. There is usually cost sharing for out-patient surgeries, hospitalization, major diagnostic tests as well as other services. Cost sharing can be a set dollar amount or a percentage of the cost.
My Medicare Advantage plan covers dental, but I can't find a dentist who accepts it. Is this a common problem?
Yes, not all plans use the same carrier for dental, and some differ between HMO and PPO. However they all have a provider search tool that we can assist with.
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
To help someone choose between Medicare Advantage and Medigap, I ask:Health Usage: Frequent doctor visits or chronic conditions? → Medigap.
Budget: Want low monthly premiums? → Medicare Advantage. Prefer predictable costs? → Medigap.
Doctor Choice & Travel: Want nationwide coverage and keep any doctor? → Medigap. Okay with networks? → Medicare Advantage.
Drug Coverage: Want it included? → Medicare Advantage. Don’t mind a separate plan? → Medigap.
Simplicity: Want one bundled plan? → Medicare Advantage. Don’t mind piecing it together? → Medigap.
It's important to have a conversation going over all of this and find out what fits best for each individual. There are lots of plans out there with different benefits. Not all may fit your needs.
I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?
Basic Original Medicare by itself is just a starting point. It covers doctor visits and hospital stays. You usually pay a monthly Part B premium and must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of your care. There is no limit to your out-of-pocket costs each year. Enrolling in a supplement plan is advisable if you want to keep your Original Medicare to cover your share of costs.Medicare Advantage helps you control costs. The plans support your entire well-being so you can live a better, healthier life. In one package, the plans give you Part A and Part B coverage, plus Part C coverage, and many of them also include Part D prescription drug coverage and other benefits. The plans have limited out-of-pocket costs, more predictable co-pays, and a cap on your yearly out-of-pocket expenses.
How can I verify if a Medicare Advantage plan's advertised benefits are legit?
CMS, Centers for Medicare Services, overseas the Medicare Part C Advantage program. By law, Medicare Advantage plans must be at least as good as Medicare, which is to say that all plans are better than original Medicare. CMS will shut down any plan advertising benefits that are not real. "They've got your back!"
I picked a PPO for the flexibility, but now every time I go out of network the bills are outrageous. What's the point of even having a PPO?
I totally understand your frustration!Having a PPO (Preferred Provider Organization) plan is supposed to give you flexibility and freedom to choose your healthcare providers, both in-network and out-of-network. But, when the out-of-network bills start piling up, it can be overwhelming.
The point of having a PPO is to have access to a wider network of providers, including specialists, without needing a referral. However, it's essential to understand that out-of-network care usually comes with higher costs.
To avoid surprise medical bills, it's crucial to:
- Carefully review your PPO plan's network and coverage
- Verify the network status of your healthcare providers
- Understand the out-of-network costs and billing procedures
If you're feeling overwhelmed or unsure about your PPO plan, I'm here to help!
As a licensed health insurance broker, I can guide you through the complexities of Medicare and health insurance. Let's work together to find a solution that fits your needs and budget.
Call me today to schedule a consultation. Let's navigate the healthcare system together and find a plan that gives you the flexibility and affordability you deserve!
My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?
Before making any decision, you should review both options. Check the cost of your medications with a standalone Part D plan and the Medicare Advantage plans with drug coverage.When on Medicare, you have the option to select a Medicare Supplement with a Standalone Part D plan (prescription drug plan) or select a Medicare Advantage plan with prescription drug coverage.
The option you choose will depend on your budget and income. I would never recommend someone have just Medicare A & B with a Standalone Part D plan because then they would be responsible for all of the Part A & B deductibles and copays.
Once you decide which option is best for you based on your budget, you can search for the Standalone Part D or Medicare Advantage plan with drug coverage that is best for you based on your medications.
As a broker, it is my responsibility to help my clients find the perfect fit.
I have Original Medicare, and I'm wondering if I'd save more on my dental cleanings if I switched to a Medicare Advantage plan instead.
Yes you can save money on dental cleanings if you switch to a Medicare Advantage plan. Most Advantage plan include $0 copay for cleanings, x-rays, preventive care, and extraction.
I picked a Medicare Advantage plan last year, and I'm not sure if my hearing aids are covered. How do I figure this out?
1. Call the member services phone number on the back of your card, and inquire as to how the hearing aid benefits work with your specific Advantage plan.2. or, call the Agent/Broker who helped you enroll in the Advantage plan. He or she should be able to give you the main points of the hearing aid benefits and then point you to phone numbers for third party contractors who provide the hearing aid benefits to this plan.
3. or, obtain the EOC (Evidence of Coverage) pdf document that outlines in detail how all the benefits work, for your plan.
Can I show my Original Medicare Card instead of my Medicare Advantage card, if my provider doesn't take my advantage insurance?
No, you cannot use your Original Medicare card if you're enrolled in a Medicare Advantage plan.When You’re on a Medicare Advantage Plan (Part C):
Your Medicare Advantage plan takes the place of Original Medicare for your medical and hospital coverage.
You must show your Medicare Advantage card when receiving care, not your red, white, and blue Medicare card.
Original Medicare will not pay for your services while you're enrolled in a Medicare Advantage plan.
If a Provider Doesn’t Accept Your Advantage Plan:
You cannot use your Original Medicare benefits to bypass the Advantage plan’s network or billing rules.
You would either need to:
Pay out of pocket, or Find a provider who is in-network or accepts your Advantage plan, or
Switch plans during an eligible enrollment period (like the Annual Enrollment Period or Special Enrollment Period if applicable).
Bottom line: If you have Medicare Advantage, that plan is your primary coverage. Your red, white, and blue card no longer applies unless you disenroll from the Advantage plan and return to Original Medicare.
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
Medicare Advantage plans can potentially save seniors money in the long run, but the impact varies by individual circumstances. They often have lower premiums and may include additional benefits not covered by Original Medicare, such as vision and dental care. However, these plans might have higher out-of-pocket costs for certain services and often require members to use a specific network of providers. It’s important for you to evaluate their healthcare needs and compare costs before choosing a plan.
My Medicare Advantage plan listed my doctor, but now they say he's out of network. How is that even allowed?
That can be frustrating! Medicare Advantage plans typically have contracts with specific networks of doctors, hospitals, and other healthcare providers. However, sometimes these contracts change throughout the year. Even if your doctor was in-network when you enrolled in your plan, they might have been removed from the network later due to changes in the insurance company’s agreements or policies.Unfortunately, this can happen, but you do have some options.
Part A Inpatient Hospital deductible $1,676 but if I have Part C Advantage Plan, the hospital $350 copay per day 1-7 so how does this work?
The Part A (IN-patient hospital) copay per day will vary among Advantage plan companies. However, the $1,676.00 has been determined by Medicare itself every new year. Since that figure is the maximum that you'll pay for that one specific hospital visit, the daily rate will be applied toward that amount. Thus, if you're in the hospital for the typical 3 days, $1,050.00 ($350.00 times 3) will be applied toward the $1,676.00. That means that you have yet to arrive at the annual deductible in that example. Since Medicare keeps track of your Inpatient hospital stays, there will be the leftover amount of $626.00 that will remain as your responsibility should you be officially admitted to a hospital within that same calendar year.
What is the biggest disadvantage of the Medicare Advantage plans?
Medicare Advantage plans have netwrork restrictions and can cost more out of pocket for deductibles and copays. Your doctor who is in network now may not be next year and the plans change annually.If you are on a Medicare Advantage plan and exceed your first 12 months and have health problems you may never be able to apply for a Medicare Supplement in the future.
I've been on my employer's health plan but am retiring soon. What should I consider when moving to Medicare?
First and foremost enroll in both Part A and B if you havent already done so.Make a list your important doctors and prescriptions. Contact an independant agent that works with many if not all of the carriers and different types of plans ie Med Sups, Medicare Advantage, Prescription Drug plans to narrow down your options for you. While you can find most of this information independently, what you wont find is the detailed information that can make a difference in your coverage. Especially in 2025 with the significant changes in ALL of the prescription drug plans. You can start the rieview and application process as early as 3 months before needing it in place...
Focus on actual care thats needed now and will happen in the future.. One of those calls I get from time to time starts with "remember that plan we talked about, I should have listened to you instead of goin out on my own" There's no cost in working with an independant agent, there could be a significant cost in not doing so..
As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?
Basic Original Medicare by itself covers Part A (hospital stays) and Part B( doctor visits). You usually pay a monthly Part B premium, which is paid by Social Security Administration from your benefits, and you must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of care. There is no limit to your out-of-pocket cost each year. You may need a supplemental insurance plan to cover 20% of the cost of care and prescription drug coverage.
Medicare Advantage plans are more comprehensive plans that support your entire well-being, so you can live a better, healthier life. You usually pay a monthly Part B premium, which is paid by Social Security from your benefits.
In one package, it gives you Part A and Part B coverage, plus Part C coverage.
Many plans also include Part D prescription drug coverage. It has limited out-of-pocket cost, It has more predictable co-pays, and a cap to your yearly out-of-pocket expenses.
Isn't it concerning that Medicare Advantage plans are taking over the system?
Is it concerning? On the one hand the only other option is a Medicare Supplement (or high deductible Medicare Supplement) or do nothing and just have Original Medicare. Being that health costs have increased significantly and that more people are looking to not pay now and pay later (as they use their plan) it is the only option. Other factors like the cost of living have made Medicare Advantage for those eligible attractive. Whereas they would have to pay a monthly premium for a Medicare Supplement. So in that regard it’s the best option for those budgeting or trying to make ends meet. On the other hand, it does leave the fact that there are 6 major Medicare Advantage companies ( there are some regional Medicare Advantage carriers) and these 6 you could say are monopolizing the market. So in that regard they’re pockets are so deep that they can lobby for laws and regulation that benefit their stock prices at the expense of the true intention of healthcareWhy would you not choose a medicare Advantage plan?
Medicare Advantage plans can be beneficial, but they come with certain limitations. These plans restrict your healthcare providers or services under the PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks. You often need preapproval for about 70% of procedures under a Medicare Advantage plan. You must have a preferred Physician as your primary physician, and a referral from your primary care physician is required to see other specialists in or outside your network.It's important to note that these plans are often designed with specific geographic areas in mind, which may limit your access to available providers outside of your local area. However, Medicare Advantage plans offer many additional services that traditional Medicare with Medigap plans may not provide, and they cover your prescription drug plans with zero to low monthly premiums. Medicare Advantage plans are only good for one year and must be renewed yearly.
Should there be stricter regulations on Medicare Advantage marketing and sales practices?
Short answer - yes and long answer it's complicated. Deceptive marketing is a problem with some marketers using confusing and misleading messages. Not to forget the people turning 65 that get a overwhelming amount of marketing calls, emails, and letters. To the point that a person feels as if they are underseige. While most agents are ethical who actually care about clients, there are definitely bad actors out there who game the system and chase commissions. People then get put into a plan that does not meet their needs.The intent of stricter regulations is good but it could also hinder the good agents but adding more red tape to do the right thing. Not every agent is going to be deceptive. Most agents have good intentions and want to do right by the client.
Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
Insurance companies offering Medicare Advantage plans are paid by Medicare to manage your healthcare. As long as you're healthy, they profit. The insurance firm works with a network of doctors who agree to set prices for their services. Medicare agrees to cover care as long as it is medically necessary. Remember, with just Medicare, you're responsible for copayments and 20%.
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
The best way to compare is to find an independent broker that you trust and whom others trust. Being fully independent allows us to show you most (or all) of the plans in your area and also to compare your current plan to a Medicare Advantage plan. They are very different plans with unique nuances and having a broker that doesn’t cost you anything is a smart way to shop!What's the key difference in how Medicare Advantage and Medigap handle out-of-network providers?
Medicare Advantage plans typically require that you stay and get your healthcare within a network of providers, and it has a potentially higher cost for out-of-network care. Meanwhile, with Medigap, you can see any doctor or hospital that accepts Medicare.
I've got a Medicare Advantage plan, and I'm curious if my upcoming eye surgery is fully covered or if I'll owe extra out of pocket.
That would be a great question to ask the provider prior to the surgery. A good ophthalmologist office Is usually very aware of the codes that they will bill to Your Medicare advantage plan And they may Tell you your cost. You should also be able to contact your Medicare advantage plans member services number and they can answer that question for you. If it is a cataract surgery, that’s a little different. Medicare fully covers cataract surgery with a standard lens. If you are using any type of upgraded lens, then Medicare will not pay for the upgraded lens And you will be financially responsible for that cost.
What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?
You can go to any doctor or hospital with Medicare Advantage. Although, there have been instances where a hospital drops the Medicare Advantage plan. You can switch plans during Medicare Advantage open enrollment. If you can't find another plan to switch to, you could return to Original Medicare and you could also pair Original Medicare with Medigap.I need a hearing aid but I've heard Medicare doesn't cover them. Is there any way around this?
Original Medicare does not cover hearing aids. However, most Medicare Advantage plans cover hearing aids and offer them at a discount or copay through their approved Vendor. Check with your local Broker if you are enrolled in a Medicare Advantage Plan.My Medicare Advantage plan advertised dental coverage, but it barely covers anything. Is this normal?
While many Advantage plans vary between networks and carriers, it's important to note that some can offer substantial coverage, and I’ve seen some reaching up to $1,700 per year for dental services. The type of coverage depends on whether it’s root canals or plain fillings, and that needs to be considered. However, it's essential to recognize that these plans may not be as comprehensive as standalone dental plans. Verify that your dental clinic is within the plan’s PPO or HMO network to maximize your benefits. This ensures you receive maximum benefits.
I picked a Medicare Advantage plan because of the dental and now I found out it only covers cleanings. Why didn't anyone tell me this upfront?
Most Medicare advantages cover more than cleanings. If you worked with a broker you needed to ask them how the dental works and what they will Cover. You can also call me and I can advise
Why is regular Medicare better than an advantage plan?
Making the choice between regular Medicare with Medigap/Medicare Supplement or a Medicare Advantage Plan depends on individual healthcare needs, preferences, and financial situations. Regular Medicare with Medigap/Medicare Supplement provides notable advantages in terms of flexibility, coverage, predictability, and support. Choosing to prioritize these factors you may find regular Medicare with Medigap/Medicare Supplement to be a superior option. Understanding the differences and benefits of each choice is essential for making an informed decision about healthcare coverage.
Why might Original Medicare with a Part D plan be better than a Medicare Advantage plan for frequent travelers?
Original Medicare combined with a Part D prescription drug plan offers flexibility, nationwide access, and consistent coverage, making it an excellent choice for frequent travelers. Unlike Medicare Advantage plans, which are often geographically limited and depend on specific provider networks, Original Medicare with Part D ensures you can access care and prescriptions anywhere in the United States without restrictions.
Why do doctors not like Medicare Advantage plans?
For Medical services and procedures, doctors need to bill the Insurance company you have your Medicare Advantage plan with. For certain services/procedures, pre-authorization is needed which takes longer with dealing with an insurance company.If you have a Medicare Supplement Plan (also called a Medigap plan) such as Plan F, G, or N then the billing and medical services pre-authorization request goes to Medicare direct, which is a simpler process.
Both billing and pre-authorization might just be simpler and quicker for the doctors to deal with. The administration with a Medicare Advantage insurance company might be more work for the doctors' administrative office.
Hope this helps ...
I want to switch to Medicare Advantage this year. How do I do this?
During the Annual Election Period (Oct 15-Dec 7) contact your local agent to enroll and your new plan will become effective January 1, 2026. If you are switching from a medicare supplement, its important to note that you'll have to call and cancel the supplement yourself it will not automatically happen.
Why do some people regret choosing a Medicare Advantage plan over Original Medicare?
If your health situation has dramatically changed, some people may wish they had a Medicare Supplement plan - usually due to choice of physicians or healthcare facilities, as Medicare Advantage plans are network driven. And it is important to note that even though your PPO plan allows you to 'see any provider of your choice,' that provider still has to agree to seeing you out of network. So that can be problematic in some cases and make them wish they had chosen a Med Supp plan. Both types of plans have their advantages and disadvantages, and it is important to understand the differences between both before making your own healthcare decision.
Do I need a Hospital Indemnity Plan if I have Medicare Advantage? What if I am hospitalized twice in the same year?
A hospital indemnity plan to work with your Medicare Advantage plan is a good idea. Your Medicare Advantage plan will have daily copays (or at least per-stay copays) and the hospital indemnity plan can pay those for you. Most policies will pay more than once in a year as long as you have been out of the hospital for a set amount of days (differs per policy) before needing to go back in the hospital. Hospital indemnity policy premiums are usually inexpensive.What is the trap of Medicare Advantage plans?
It's important to understand that Medicare Advantage is not the same as traditional Medicare. Medicare Advantage is a type of group insurance plan created by an insurance company that adheres to Medicare guidelines to serve beneficiaries. Although some Medicare Advantage plans may have a zero monthly premium, they often come with various other cost factors that can arise when using the coverage. Here are some key points to consider when switching to a Medicare Advantage plan:1. Some individuals may encounter difficulties when trying to switch back to traditional Medicare after enrolling in a Medicare Advantage plan, particularly due to their health conditions.
2. Medicare Advantage plans operate within provider networks, such as PPO and HMO networks.
3. Approximately 50 to 70% of surgeries or other therapies may require prior approval.
4. Coverage is subject to specific geographic areas, and you may need to obtain approval for services outside those areas.
5. Under Medicare Advantage, your out-of-pocket costs for one year of service could be significantly higher than with traditional Medicare combined with Medigap, especially if you have serious health conditions.
6. Medicare Advantage programs must be renewed each year, and the plans are subject to change annually.
Why are people unhappy with Medicare Advantage plans?
I believe that most people who are unhappy with MEDICARE ADVANTAGE are enrolled in the wrong Plan to begin with. Too many people scratch around on the Internet and see a low price or answer the telephone and sign up with a harassing caller who puts them in a Plan without knowing all of the facts necessary to get the correct Plan.Also... many Agents are only licensed by certain Insurance Carriers so people end up i the wrong Plan. A good Independent Broker would show clients the good and bad of all Plans, letting the client make the correct choice for their situation.
What's the best way to avoid surprise bills for lab tests under Medicare Advantage?
When having lab tests done check with your Advantage plan agent or customer service center to ensure you are staying IN NETWORK! Also ask the medical provider ordering the labs if these are standard, common and preventative tests or if they are more rare. The insurance company can also help with pricing if they have all the information.
Why are seniors losing Medicare Advantage plans?
Many things can factor in to the loss of a medicare advantage plan. Plan could move out of the service area or be discontinued, you could drop your Part b benefits with social security causing your medicare advantage plan to drop or the loss of medicaid status, depending on the plan, can cause your medicare advantage plan to drop. Anything that changes your eligibility for a plan can cause a medicare advantage plan to drop.What if I missed my window to sign up?
If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.
What are disadvantages of HMO?
• Limited provider networks• Most require referrals from your primary care doctor
• Out-of-pocket costs like deductibles, copays, and coinsurance
• The big one — prior authorizations are often required for many services
My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?
You are correct. PPOs do not require referrals. But there are "office policies" that require one. The insurance company can't force the practice to not require one.Do Medicare Advantage plans save money?
The question of whether Medicare Advantage plans save money is complex, with varying perspectives. Here's a breakdown of key considerations:Potential Cost Savings for Individuals:
* Lower or Zero Premiums:
* Many Medicare Advantage plans offer low or even $0 monthly premiums.
* Out-of-Pocket Maximums:
* These plans typically have a limit on your annual out-of-pocket expenses, providing a degree of financial protection. Traditional Medicare lacks this cap.
* Additional Benefits:
* Many Medicare Advantage plans include benefits not covered by Original Medicare, such as dental, vision, and hearing care, which can lead to cost savings if you utilize these services.
* Consolidated Coverage:
* Medicare Advantage plans often combine Medicare Part A, Part B, and Part D (prescription drug coverage) into a single plan, streamlining costs.
Concerns About Overall Costs:
* Higher Costs to the Medicare System:
* Reports, such as those from the Medicare Payment Advisory Commission (MedPAC), indicate that Medicare Advantage plans can cost the Medicare system more than Original Medicare. This is due to factors like how the plans are paid, and coding intensity.
* Potential for Hidden Costs:
* While premiums may be low, Medicare Advantage plans can involve copayments, coinsurance, and other out-of-pocket costs that can accumulate.
* Prior Authorizations and Network Restrictions:
* Medicare Advantage plans often require prior authorizations for services and have network restrictions, which can limit access to certain providers and potentially lead to unexpected costs.
In summary:
* For some individuals, Medicare Advantage plans can offer potential cost savings through lower premiums and added benefits.
* However, from the perspective of the overall Medicare program, there are concerns that these plans may increase costs.
* It is very important for an individual to carefully review the details of any medicare advantage plan they are considering.
What's the process for signing up for Medicare if I'm already on disability benefits?
After being on Disability for 2 years you are automatically enrolled in Medicare even if you have not reached 65 yet.
Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Yes Some Medicare Advantage plans may cover Acupuncture. Always check your Summary of Benefits. The Acupuncture benefit could be covered for chronic low back pain only. Not all providers could be included.also See page 30 in your Medicare and You Handbook 2025
I have Medicare Advantage with a PPO, and I'm curious if my annual wellness visit is free or if I'll owe something for it.
Your plan more than likely will have a zero dollar co-pay for your annual wellness visit however, it’s always a good idea to double check your summary of benefits to make sure.
What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?
Benefits that are advertised nationally that only a super small percentage of the population (usually poverty level) qualify for. It's misleading for our senior population and creates confusion when there doesn't need to be any.
Which is better: a Medicare Advantage Plan or a Medigap policy?
There is no cookie cutter answer for this question so it's one of the most confusing, and requires the most amount of interviewing and planning to give someone the most concise answer. For example, I have met with people who were turning 65 that wanted a Medicare supplement. But after meeting with them, we found out that they were eligible for federal and state assistance that would not require them to pay for a Medicare supplement. So they were very relieved to know that they did not have to take out a Medicare, supplement and They were also not going to be required to pay the $185 monthly Medicare, part B premium. Make sure you are meeting with a unbiased Insurance agent face to face l. This can help alleviate a lot of concerns and making sure you're getting the most concise planning for your healthcare as you age.
With the supplements being so expensive in climbing in price every year, what is your take on hospital indemnity policies added with advantage policies?
I believe adding a hospital indemnity plan may be a great solution to protect yourself from high copays for inpatient hospital stays and even ambulance copays. If approved for an indemnity plan, the cost are typically much lower than a Medicare Supplement and are often coupled with $0 premium Medicare Advantage Plan which is very affordable for those trying to stay within a specific budget yet still have peace of mind that a hospital stay will not hurt your wallet too much.
When can I change my Medicare Advantage Plan?
The next are special enrollment periods that can vary throughout the year. Maybe you lost employer group coverage, or you got Medicaid or extra help for your prescription drug costs. There are many different reasons. I would check with your broker or your agent, and they can help you figure out if you're eligible to change plans at that time. I hope this helps.
I exercise regularly and maintain a healthy lifestyle. Does Medicare offer any incentives or additional benefits for preventive health behaviors?
A few Medicare Supplements and some Medicare Advantage plans have a benefit for gym memberships. Some Medicare Advantage plans will pay you a specific dollar amount for preventative visits. I would not choose a plan based on these benefits. Focus on the quality of the medical coverage. Please contact your local agent for more information about the plans in your area.Isn't it suspicious that Medicare Advantage plans offer gift cards and incentives to enroll?
I do not feel it is suspicious, but it is against regulations. Offering such gift cards to entice a beneficiary to enroll is not permitted.Offering gift cards to beneficiaries for completing health assessments is permitted, but not for enrollment.
My Medicare Advantage plan denied coverage for a specialist I need to see. What are my options now?
Your primary care physician may need to make the referral before its approved by your plan, especially if you have a HMO plan vs a PPO or HMO-POS plan where you can select specialists on your own instead of through your primary care provider. The other situation is the specialist you selected may not be in network. Again with HMO plans you always need to stay in network. With a PPO plan, you can choose a specialist who is not in network, but you will pay significantly more if you do. Check either with your agent or the customer service to find out what your options are to resolve this issue.Why are people leaving Medicare Advantage plans?
What is the Medicare Advantage 5-Star Special Enrollment Period? Is this different from '"OEP'" and "AEP"?
Do your clients use Medicare Advantage over-the-counter drug cards? How does that work?
The Over The Counter (OTC) benefits are pretty nice and most of the people I work with will use them. All of the different plans vary some on how to use them. Some plans will give you a card to use at different locations and some you can log in or phone in your order of OTC items and they are mailed to you at no additional cost. All of the plans also vary on how much they will give you in extra OTC benefits. This past year, most of the plans cut the OTC benefits down 30-50% from last year. I feel this is a direct result in how much the government will subsidize these plans and my thought process is that the next couple years, I could easily see the government continue to cut the amount of money given back to these plans. Again, just my thoughts.
I have heard of some people's providers dropping their Medicare Advantage plans. Should I be worried about this?
Yes, this has become more of an issue lately because of inflation and the impact of the IRA on insurance companies and providers. However, it is still a relatively small issue in the grand scope of Medicare Advantage. Many plans maintain great networks and network outages are many times short lived.
What are disadvantages of PPO?
Most of the time, all I see is slightly higher co-pays and slightly less extra benefits than HMO plans. The biggest reason to go with a PPO is if you are planning on traveling a lot or have a plethora of medical professionals you see for several different reasons. I hope this helps.
Can I switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if I’m diagnosed with a serious illness?
The short answer is no. Medicare advantage changes are generally only allowed during (AEP) annual enrollment period (Oct 15 - Dec 7). Then you get another chance to make one more change during (OEP) open enrollment period (Jan 1 - Mar 31). Any changes outside these dates need a special enrollment period (SEP) and a diagnosis of an illness isn’t necessarily a reason for one.Medigaps are underwritten. If you have a serious illness you may not qualify. If you are still in your initial enrollment period (3 months before your birthdate, the month of, and 3 months after) of 7 months.
Harold Randolph
MI KY IN OH
Why are hospitals not taking Medicare Advantage plans?
Hospitals negotiate with insurance companies and plans for payments. Depending on the plan's payment structure, a hospital (or any care provider) makes a business decision to accept the plan(s). Hospitals generally sign multi-year agreements with the insurance carriers.
Does Medicare Advantage cover home health care?
Yes, if your doctor orders it. However, Medicare does not cover 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, or custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need. Some Medicare Advantage plans include some homemaker services when returning home from the hospital, so ask your broker.
How can insurance companies afford to offer Advantage plans with $0 monthly premiums?
Insurance companies can offer Advantage plans with $0 monthly premiums because they get money from the government. Here's how it works:Medicare pays them: The government pays insurance companies a set amount of money each month for each person enrolled in a Medicare Advantage plan. This amount is often enough to cover the cost of providing health services.
Managing costs: Insurance companies often negotiate discounts with doctors, hospitals, and other providers to keep costs low. They also manage care carefully to avoid expensive treatments.
Additional benefits: Sometimes, Advantage plans offer extra perks (like gym memberships or dental coverage) to make them more attractive. These extras are often covered by the government payments and are not a burden to the insurance company.
In short, the government pays the insurance company a fixed amount, and the company can make money by carefully managing costs.
Las compañías de seguros pueden ofrecer planes de Advantage con primas mensuales de $0 porque reciben dinero del gobierno. Así funciona:
Medicare les paga: El gobierno paga a las compañías de seguros una cantidad fija cada mes por cada persona inscrita en un plan de Medicare Advantage. Esta cantidad generalmente es suficiente para cubrir el costo de los servicios de salud.
Gestionando los costos: Las compañías de seguros a menudo negocian descuentos con médicos, hospitales y otros proveedores para mantener los costos bajos. También gestionan la atención cuidadosamente para evitar tratamientos caros.
Beneficios adicionales: A veces, los planes de Advantage ofrecen beneficios extras (como membresías en gimnasios o cobertura dental) para hacerlos más atractivos. Estos extras generalmente son cubiertos por los pagos del gobierno y no suponen una carga para la compañía de seguros.
En resumen, el gobierno paga a la compañía de seguros una cantidad fija, y la compañía puede ganar dinero gestionando cuidadosamente los costos.
What are the types of Medicare Advantage plans?
Medicare Advantage plans usually fall into three categories:1) Standard MAPD plans. These plans are typically offered on a HOM PPO managed health platform and include Rx benefits.
2) Dual Eligible Plans (D-SNP): These plans are designed to work with your state Medicaid benefits.
3) MA only plans: These plans use HMO/PPO managed health plans. The majority is PPO. These plans DO NOT include RX benefits like a standard MAPD does. These plans are designed to be used in conjunction with VA or TRICARE benefits.
There are a few lesser-used Advantage plan options, such as Medicare Cost plans, Medicare Savings Plans, and C-SNP (chronic special needs plans), but these are not widely available or utilized.
I'm confused by all the star ratings for Medicare plans. Do they actually mean anything for the care I'll receive?
Medicare Star Ratings measure the quality of Medicare Advantage and Part D plans.If you have a Medicare Advantage plan, you should know about the star rating on your plan.
Star rating uses a 1 to 5-star scale.
A 5-star rating means excellent performance. The ratings are based on factors like member satisfaction, customer service, and health care quality. Plans with higher stars often offer better care and service. Ratings are updated yearly by Medicare to help beneficiaries compare plans and make informed choices. Choosing a higher-rated plan can improve your overall experience and access to care.
You may also switch to a 5-star plan during a special enrollment period, even outside of the usual enrollment times.
I am moving to a different county in my same state, should I look at getting a new Medicare plan?
If you are on an Advantage you should check with them to be sure they are in your new countyIf not you will need to change plans, also be sure to notify SSA with your new address
If someone enrolls in a MAPD C-SNP and gets disenrolled for not providing a CCV form within 60 days, is there a SEP to enroll in another MAPD plan?
Yes, if someone is disenrolled from a Medicare Advantage C-SNP for failing to provide a required Chronic Condition Verification (CCV) form, they generally have a Special Enrollment Period (SEP) to enroll in another MAPD plan. This SEP typically begins when the individual is notified of their disenrollment and lasts for two months.Thanks for reaching out.
Dawn Young
HealthMarkets Insurance Agency
How do Medicare Advantage star ratings affect the quality of care I can expect?
Generally, yes star ratings are an important factor when choosing a plan.Medicare rates plans based on their health and drug services from poor to excellent. (1 to 5 stars)
5 star rating is the highest/Excellent.
Star ratings are based on factors that include:
1. Feedback from members about the plan's service and care
2. The number of members who left or stayed with the plan
3. The number of complaints Medicare got about the plan
4. Data from doctors and hospitals that work with the plan
What is the Medicare Advantage 3 midnight rule?
The Medicare three midnight rule is a rule that requires traditional Medicare beneficiaries to have three consecutive nights in a hospital before they will cover care in a skilled nursing facility. They do not include any observational days or the day you are discharged. this rule may or may not apply if you are on a Medicare advantage plan because private carriers can waive the rule if they choose. If you have more questions about this rule, you can reach out tothe Center for Medicare and Medicaid services. You may also call a licensed professional for guidance.How do I find local Dentists that take my Medicare coverage?
Medicare does not cover dental services. They are usually included as an add-on in Medicare Advantage plans, but these are typically HMO dental plans, which may have a smaller network. If you see a specific dentist, I recommend asking your dentist which dental plans they accept and purchasing the plan with which your dentist is contracted.What's the most misleading Medicare Advantage ad you've seen, and how do you explain the reality to clients?
An agency out of state sent a Medicare Advantage plan ad/mailer to my husband. The plan they were advertising was a plan not in our zip code or county. I called the agency and it took a bit of time for him to tell me that United HealthCare plan is not available where we live. I contacted United HealthCare about this ad. Hopefully they contacted the agency. When shopping around for a Medicare plan, please contact a local agent who will care if you happy with your plan and will try to keep you happy to keep your business.
Is occupational therapy covered by Medicare Advantage with UnitedHealth?
Yes, occupational therapy is generally covered by UnitedHealthcare Medicare Advantage plans, provided it is deemed medically necessary by a doctor. All Medicare Advantage plans are required to cover at least the same services as Original Medicare Part B, which includes outpatient occupational therapy. Check for prior authorization also!Don't you think Medicare will eventually be privatized completely?
This is a considerable debate among Medicare beneficiaries and our government. The possibility of prioritizing Medicare is happening through the Medicare Part C Advantage plans, known as managed care under the supervision of major insurance companies. However, it is in the individual's choice to choose which direction they're going with Medicare. As Medicare Advantage plans continue to improve their services and networks of managed care, we will see more and more individuals moving in that direction.Suppose traditional Medicare Part A and Part B, with a Medigap plan, offered similar services like dental, hearing, and vision coverage to Medicare Part C advantage plans. In that case, they may not be as attractive. Traditional Medicare does not have in-network services, so you can use your benefits anywhere that they will take Medicare.
Isn't Medicare Advantage just private health insurance? What is the difference?
Pretty much correct! The only thing is that it will cover what would be allowed by Medicare for these services. As a Private Company, they can change coverages and accepted charges or not. They can limit the services they offer you or keep you in a Network, where there is none in Original Medicare. And because the Doctors and facilities are paid from a Private entity, they may not be paid as much or as fast as Original Medicare pays. Therefore, you need to ask yourself if a better professional would then accept being paid less and later than those who will not accept it! When you accept the lower frontal costs of MA plans, what is it really costing you? This is why it is so important to do this right when you first come into your Medicare Open Enrollment!
Will Medicare Advantage plans start offering more digital health tools like apps by 2030?
It would seem likely that Medicare Advantage would start offering more digital health tools by 2030 simply because, like any other business, they need to keep up with the times as well. As the younger population ages, there will be more tech-savvy individuals aging into Medicare.
Don't you think Medicare should ban all those celebrity Medicare Advantage commercials?
In my opinion, yes. They are misleading and cause a lot of confusion with Medicare beneficiaries. I usually have to address misinformation caused by those commercials on a daily basisIf we choose a Medicare Advantage plan and later regret it, can we go back to Original Medicare without penalties?
Yes! You can return to Original Medicare without penalties. But this can only be done during AEP, OEP, or SEP. Be careful when you're changing. I recommend meeting with a licensed Medicare agent or contacting Medicare directly.What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?
Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.Are some Medicare Advantage providers better than others?
That depends on where you live. If you live in a large metropolitan area, you'll have more choices. Living in a rural area, you'll have limited choices or no choice at all. Medicare Advantage plans do have a Star rating. You can call Medicare to ask about some of the 4 and 5 Star plans. Work with a licensed Medicare agent to review the plans available in your area.
How will the recent attention & auditing around Medicare Advantage plans effect nursing home coverage?
The recent attention and increased auditing of Medicare Advantage plans is focused on ensuring these plans are following the rules and putting patients’ needs first. One area under scrutiny is how these plans manage care in nursing homes—particularly the use of prior authorizations and decisions around how long someone can stay in a facility.What this means for nursing home coverage is that we may see improvements. Audits are likely to reduce practices that led to early discharges or delays in care. The goal is to make sure that if someone truly needs skilled nursing care, they can access it without unnecessary barriers.
That said, it’s more important than ever to have an advocate who understands how each Medicare Advantage plan handles post-acute and long-term care. Plans vary, and being on the right one can make a real difference in what care you or your loved one receives.
Can my Medicare Advantage plan offer extra coverage for breast cancer services?
Some plans have value added services for chronic iillness. check what is called C Snp plans in yoyr area or go to medicare.govIf I’m in a Medicare Advantage plan, will I still need prior authorization for procedures next year?
But on a Medicare Advantage plan, for all intents and purposes, you have to get authorization from your carrier in reference to getting a procedure. So again, there are limitations to Medicare Advantage. But I highly recommend that you sit down with a licensed Medicare agent or your agent who helps you with Medicare to figure out what options you have and whether or not you can make any changes.
So hopefully that answers your question.
Do Medicare Advantage plans work in rural areas?
Folks in rural areas will have a difficult time utilizing Medicare Advantage plans. Because MAPDs are focused on a provider network and rural areas have fewer providers it is difficult for a carrier to establish a sustainable network in less populated areas. PPOs were once an option however they are not profitable for the carriers so they are becoming less available.Are there any guidelines I should follow when filling out my Medicare application?
The guideline for completing an application to enroll in a Medicare plan is pretty simple. The question should be: do you understand what you are signing up for and how your Medicare plan will work for you today and in the future as your healthcare needs change? I would recommend working with a knowledgeable agent or broker who can help you choose the right plan.How is Medicare Advantage expected to evolve in the future?
Medicare Advantage is expected to soon be the more popular form of Medicare coverage. Enrollment for Medicare Advantage plans is growing and expected to continue to grow.What’s the difference between what Original Medicare covers and what a Medicare Advantage plan might include for holistic care?
Its been my experience that holistic care, by and large is not covered with the exception of some Medicare advantage plans covering acupuncture. Vitamins can be a covered expense on some over the counter plans with Medicare advantage plans as well.
What is the Medicare Advantage (Part C) Open Enrollment period?
So that period is, it's a real thing. It is a real thing. Medicare Advantage has its own open enrollment after AEP, the annual enrollment period. It's called open enrollment. I know it's crazy, but it's from January 1st to March 31st. If you're on an Advantage plan, you can change to another Advantage plan. If you're under an Advantage plan, you can go back to original Medicare and do a drug plan, so you can change. If you're on original Medicare and on a supplement, you can't change to it.
Also, January through March is the general election period. If you didn't go on Part A or B and you're already retired and just hanging out there, and you need to go on it, that's when you go on one of those parts. But January to March, so if you made a mistake during open enrollment, boom, you can correct it one time here, January to March. If you missed open enrollment, boom, you get another, you get a secondary chance for your Advantage to change your Advantage.
So that's Medicare Advantage open enrollment period, January 1st to March 31st. After that, it's a special election period. So you got to be cautious if you need to make a change. Make a change now. All right, hope that helps. If you have any questions, we'll send out an agent to help you out. Have a good day.
Can You Be Denied a Medicare Advantage Plan?
There are times you cannot change plans, if you have an enrollment period, you should be able to do that..Daniel Brechin
Contact me.
Does Medicare cover SilverSneakers gym memberships?
Original Medicare does not cover SilverSneakers or gym memberships. However, many Medicare Advantage plans and some Medigap plans include SilverSneakers as an extra fitness benefit at no additional cost.If your plan includes it, you can access participating gyms, fitness classes, and online workouts using your SilverSneakers membership ID. Coverage varies by carrier and ZIP code, so you should check your specific plan benefits or use the official SilverSneakers eligibility tool.
Is there a penalty for switching from Medicare Advantage back to Original Medicare?
There is no penalty for switching from Medicare Advantage to Traditional Medicare. There are some things to be aware of though. Remember, if your Advantage plan had drug coverage, you now need to add a stand a lone Part D Drug plan. Also, you can only make the switch during one of the approved enrollment periods.I've been retired and on Medicare for 4 years. Why did my Part B premium increase by almost $100?
Your part B premium is based on your income from 2 years prior. Most often, a large increase in your Part B premium, after being on it for several years, is due to an IRMAA surcharge you incur due to a large influx of income. The most common causes of this include a large IRA withdrawal, the sale of a business, the sale of real estate, or a ROTH conversion. The proceeds from all these transactions are counted as income. This increase could trigger an IRMAA charge that will last for a year.What is an HMO-POS Medicare Advantage plan, and how is it different from an HMO or PPO?
On an HMO/Pos plan, you must select a primary doctor. You can go to any provider without a referral in the network, and you can go to a non-network provider, but you pay a higher copay.
On a standard HMO you must pick a primary care provider, and you must have a referral.
No out-of-network benefits
On a PPO, you don't have to pick a primary doctor, and you can freely go out of network
PPO. will give you the best choice of providers
How can I tell if my Medicare Advantage plan is financially sustainable long-term?
Consider these factors:Review the plan's premium and out-of-pocket costs annually for increases.
Check the plan's network of providers and any changes that may affect access.
Evaluate the coverage options and benefits to ensure they meet your needs.
Monitor the plan's star ratings, which indicate quality and performance.
Research the insurer's financial stability through ratings from agencies like A.M. Best.
Stay informed about any changes in Medicare policies that could impact your plan.
Why have millions of seniors suddenly lost their Medicare Advantage coverage?
Because of the reduction in payments to medicare and medicare advantage companies there has been a pull back in especially rural areas with respect to these plans.
Do doctors prefer Medigap or Medicare Advantage plans?
Doctors generally accept both types of coverage. Some may have a preference, but what truly matters is choosing the option that best fits your needs. There are many factors that go into deciding which plan is right for you, so it’s important to look at your personal situation and what kind of coverage will serve you best.
How can Medicare Advantage plans have a $0 premium? Where does the money come from?
Medicare pays the insurance companies a certain amount per member per month and transfer responsibility of care to the plan. In exchange, the plans must offer actuarial benefits equivalent or better than Original Medicare
Can I change my Medicare plan after open enrollment ends?
Yes, if you have LIS low income subsidy or extra help. If you moved to a new county or state. If you newly receive Medicaid. If you lose your Medicaid benefits, these all things that open you up to SEP Special Enrollment periods. If need help or advice call us today.
How do I switch back to Original Medicare from a Medicare Advantage plan, and will I face any penalties or coverage gaps?
You can switch back to Original Medicare by disenrolling from your Medicare Advantage plan during designated federal enrollment windows. While you will not face financial penalties for switching back, you may experience significant gaps in supplemental coverage (Medigap) or face a Medicare Part D late-enrollment penalty if you do not orchestrate the transition correctly.
How do I change my Medicare plan during open enrollment?
To change your Medicare plan during Open Enrollment, you can contact your current agent or broker or contact us.If you call the company direct, they will enroll you in one of their plans.
If you call an agent who works for a company, they will enroll you in their specific company’s plan.
However, if you contact a Medicare Broker, we will shop the carriers to find the best plan for you.
Thanks for asking
Are there really zero-premium Medicare Advantage plans, and what's the catch?
There are usually zero-premium plans available in most areas. Some do not but most area do. The coverage usually involves paying a copay whenever you use the plan so if you are someone who uses the insurance many times a month for very large amounts of dollars out of your pocket you would be best suited for a Medicare Supplement.
Does moving to a new state let me switch from Medicare Advantage to Medigap without health questions?
Yes. If you move out of your Medicare Advantage plan’s service area, you have a guaranteed issue right to buy certain Medigap plans without health questions. That usually includes Plans A, B, D, G, and in some cases C or F if you were eligible for Medicare before 2020. You may have additional rights under state law.
Are Medicare Advantage plans guaranteed issue?
Yes — Medicare Advantage plans are generally guaranteed issue as long as you are enrolled in Medicare Part A and Part B and live in the plan’s service area. Unlike Medigap plans, Medicare Advantage plans typically do not use medical underwriting, so you cannot be denied because of health conditions.However, you must enroll during a valid enrollment period, such as your Initial Enrollment Period, Annual Election Period, or a qualifying Special Enrollment Period.
The main exception is for people with End-Stage Renal Disease (ESRD), though most ESRD restrictions have been removed in recent years.
What is the biggest coverage gap most people don't know about with a Medicare Advantage plan?
There are many: in/out of network costs, inpatient admissions costs, chemotherapy, skilled nursing costs and network restrictions, possible travel/network restrictions, just to name a few. Each plan has a lengthy summary of benefits which is required to list required co-pays/cost of care within the parameters of the plan.
Do I need to carry my Medicare card if I have a Medicare Advantage plan?
If you have a Medicare Advantage plan, you should carry your Medicare Advantage plan card, since that is the card doctors, hospitals, and pharmacies will usually need to bill your coverage. Most providers will not use your red, white, and blue Medicare card for routine services once you are enrolled in Medicare Advantage.It’s still a good idea to keep your Medicare card in a safe place at home and know your Medicare number if needed. In most situations, your Medicare Advantage card is the one you’ll present when receiving care.
What is a $0 premium Medicare Advantage plan, and what's the catch?
A $0 premium Medicare Advantage plan means you don’t pay a monthly premium to the insurance company for that plan. The ‘catch’ is you pay as you go instead: copays, coinsurance, and deductibles when you actually use care, and you have to follow that plan’s network and rules. However, this is also true if you have a premium for said policy. Some people like that trade‑off, some don’t, so it’s really about whether the plan’s copays and doctors fit how you actually use healthcare.Browse Other Questions & Answers
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