Medicare Advantage Insurance

Is a Medicare Advantage Plan better than a Medicare Supplement Insurance Plan?
Hard to say. They are very different approaches to covering the same needs. The supplement pays your share of the expense after Medicare has paid (your doctor files two claims). With the Medicare Advantage insurance plan, your doctor/provider files one claim with an insurance company and Medicare does not pay claims any more. Medicare pays the premiums for the insurance provided by the Medicare Advantage insurance Plan. Medicare rules require the insurance company to cover all health claims at least the same as Medicare or better. They are nearly always paying “better” than Medicare (but not better than Medicare plus a supplement) in order to market their insurance plan against Medicare, offering lower monthly premiums (often as low as -0-), and such extras as dental, and vision services and a Prescription card. A Medicare Supplement plan will typically cost $1,200+ a year or more in premium (increasing yearly) and then to add a Prescription card will cost another $500 a year. The Medicare Advantage Insurance Plan may have a $-0- premium but various copays and deductibles for their services. You have to decide if the required annual premium for the supplement plus the Prescription card is better or worse than having to pay the various deductibles/copays you may have to pay in the Medicare Advantage Insurance Plan.

To summarize, in my opinion, your strongest coverage is to have Medicare and then have a Medicare Supplement Insurance plan, Plan F; then you will basically have 100% coverage for all Medicare approved services. You will also have the most expensive medical plan and will not have coverage for dental, vision, or even, in some plans, a gym membership.

If I sign up for a Medicare Advantage Insurance plan do I lose Medicare?
No. You never lose Medicare. However, you are agreeing to allow Medicare to transfer the responsibility for your medical care to the insurance company for the year. Medicare pays the premium for the insurance on your behalf. You still pay the monthly Medicare deduction from your Social Security (or pay directly if not on SS) whether on a Medicare Advantage insurance plan or not. You can go back to Medicare at the end of each year, stay with the plan you are with or go to another plan or company.

I have insulin diabetes; can I sign up for a Medicare Advantage Insurance Plan?
Yes. Medicare Advantage Insurance plans require no underwriting. They accept all applications with one exception: they do not accept renal failure (dialysis). There is even a special category of Medicare Advantage Insurance plans they call Special Needs Plans (SNP Plans) that are specifically designed for certain conditions like Diabetes and Heart Failure. These plans offer special extra services related to these conditions within their plans.

Does a Medicare Advantage Insurance plan cover me everywhere?
If traveling and an emergency occurs, yes, always. Otherwise maybe. These plans come in various designs. One is a PFFS which means any accepting Medicare approved physician or provider anywhere. Another is a PPO which means the insurance company has a list of physicians and providers that you will receive the highest benefit if you use them. If you use a non PPO provider then your benefit is lowered and you pay the difference. Another is an HMO which means that the insurance company has a list of physicians and providers and you must use them or no benefits are paid by the insurance plan. With this last plan, if you wanted surgery from a specialist in Houston and this physician and his hospital were not on the HMO list, then you would pay the entire bill. As you might expect, the HMO’s have the most generous benefits and if you live in a large metroplex often have excellent provider lists (most physicians and providers participate).

When can I sign up?
You can sign up when you are eligible for Medicare and during the AEP (Annual Election Period) which is October 15 through December 7. You may also sign up under select exceptions such as moving to a different county or state and your old plan doesn’t cover you there.

If I sign up for a Medicare Advantage Insurance plan and do not like it, can I return to my Medicare Supplement Insurance plan?

Federal law allows a person to sign up for a Medicare Advantage Insurance plan and within the first 12 months (no more than 12 months) return to a previously held Medicare Supplement Insurance plan guaranteed issue (no health questions). After 12 months you would have to reapply the same as any new customer for a Medicare Supplement Insurance Plan and go through underwriting. Remember that you can only leave a Medicare Advantage Insurance Plan during the MADP (Medicare Advantage Disenrollment Period) which is from 1-1 through 2-14 and during the AEP (Annual Election Period) which is October 15 through December 7.