What Is a Medicare Advantage Plan?

A Medicare Advantage Plan is the primary alternative to Original Medicare. However, unlike Original Medicare, Medicare Advantage comes in many different plan types. Many people choose to go with a Medicare Advantage Plan, which offers all the same benefits of Medicare Part A and Part B — plus a few extras. The primary difference is that Medicare Advantage is brokered through a private insurance provider, while Original Medicare is a federal insurance program. Thus, many older adults find that a Medicare Advantage Plan offers more specialized benefits and, in some cases, lower costs.

To help you gain a better understanding of Medicare Advantage, we’ll cover helpful answers to some of the most common questions regarding coverage options, costs, and plan types.

Does Medicare Advantage Cover Everything?

In short, no, Medicare Advantage does not cover everything. In fact, no private insurance plan covers absolutely every medical service. However, by law, Medicare Advantage must provide, at a minimum, the same coverage as Original Medicare.

What Is Not Covered?

This is difficult to answer as Medicare Advantage plans can vary in their coverage. While they all cover the same things as Medicare Part A and Part B, some also provide Part D prescription drug coverage, as well as dental, vision, and hearing. However, here are a few things that most Medicare Advantage plans do not cover:

  • Long-term care
  • Cosmetic surgery
  • Acupuncture
  • Routine foot care

Do Medicare Advantage Plans Pay 100%?

No, Medicare Advantage plans do not pay 100% of the cost of your medical expenses. The exact amount you pay will depend on your individual plan and the type of service you receive. That said, once you’ve paid your deductible, you can generally expect Medicare Advantage plans to pay 80% of the cost for covered services.

Why Are Medicare Advantage Plans So Cheap?

Since Medicare Advantage is a private insurance plan, prices are more competitive. As a result, providers can offer lower premiums, deductibles, and coinsurances for many older adults.

Is Medicare Advantage Based on Income?

No, Medicare Advantage is not based on income. Alternatively, Original Medicare Part B premiums and Medicaid are based on income. For this reason, people often assume that Medicare Advantage plans use income as a factor when calculating costs (but they don’t).

Why Choose a Medicare Advantage Plan?

Medicare Advantage plans generally offer more coverage and lower costs than Original Medicare. Additionally, you can choose between different plans that accommodate specific needs. For example, a Health Maintenance Organization (HMO) Medicare Advantage plan offers lower costs for people who receive care within a designated network, while a Special Needs Plan (SNP) offers coverage for people with specific diseases, conditions, or disabilities.

What Are the Pros and Cons of Medicare Advantage Plans?

The following includes some pros of Medicare Advantage plans:

  • Lower costs: Premiums and deductibles are generally lower than Original Medicare
  • Greater coverage: Potentially including prescription drugs, vision, dental, and/or, hearing
  • More flexibility: You can choose different kinds of plans to fit your specific needs and budget

Alternatively, here are the cons of Medicare Advantage plans:

  • Lack of coverage while traveling
  • Certain provider limitations
  • Additional costs for certain services

Is Medicare Advantage Better Than Original Medicare?

This is a difficult question to answer, as it can vary for each individual. That said, Medicare Advantage is best for those who want to consolidate Part A, Part B, and Part D into one plan. Additionally, Medicare Advantage plans provide more options and coverage than Original Medicare. However, older adults who are already receiving Social Security when they become eligible for Medicare are automatically enrolled in Original Medicare, which takes away the stress of finding and enrolling in a plan. Moreover, Original Medicare beneficiaries have the option to add a Supplemental Medicare (Medigap) plan, while Medicare Advantage beneficiaries do not.

Can You Switch From Medicare Advantage Back to Original Medicare?

Absolutely. You can switch between Medicare Advantage and Original Medicare anytime during the General Enrollment Period (January 1st to March 31st) or the Medicare Open Enrollment Period (October 15th to December 7th). Additionally, you may be able to switch during Special Enrollment Periods or your Initial Enrollment Period.

Is Medicare Advantage Better Than a Medicare Supplement Plan?

It’s hard to compare these two plans because they are completely different. A Medicare Advantage plan consolidates Part A, Part B, and often Part D with other coverage options. Alternatively, Medicare Supplement is additional coverage that can be added to Original Medicare to help pay for the cost of deductibles, premiums, and coinsurances. You will need to evaluate your needs and budget to decide which option is best for you.

The Bottom Line

Often times, people usually have a lot of questions about Medicare Advantage. Fortunately, it’s not as complicated as it might seem. In essence, Medicare Advantage is just an alternative to Original Medicare that potentially offers more benefits. If you’d like to learn more about Medicare Advantage or your other Medicare coverage options, feel free give us a call anytime at (866) 327‑0148Medicare-Subsidy.com‘s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.