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Medicare Advantage

What is Medicare Advantage

A Medicare Advantage Plan, or Medicare Part C, is a Medicare health insurance policy providing medical and hospitalization benefits as well as medication coverage in most cases. This type of plan is offered by a private insurance company as an alternative way to receive Original Medicare (Parts A & B) benefits. Medicare enrollees often decide to receive healthcare coverage through a Medicare Advantage plan because many of these Medicare Part C plans can have more benefits (such as vision, dental, hearing, and health/wellness plans) than Original Medicare and most Medicare Advantage Plans provide prescription drug coverage.1

Medicare Advantage Plan Types

Medicare Advantage HMO – With Health Maintenance Organization (HMO) plans, you typically must receive your healthcare services within that plan's network of doctors and medical facilities. In some exceptions, such as emergency care or dialysis treatments received out of area, you can receive services out of network. Some Medicare Advantage HMO Plans (those with a point of service option), allow you to go out-of-network, usually at a higher cost.2

Medicare Advantage PPO - In a Preferred Provider Organization (PPO) plan, you can typically receive services from any doctor or hospital but will pay less if they are part of the plan's network. Services received from out-of-network doctors and medical facilities come with an additional charge.3

Medicare Advantage PFFS – With Medicare Advantage Private Fee for Service Plans, the plan determines how much it will pay for healthcare services. As long as the doctor or hospital agrees to treat you and agrees to the terms of payment, you can typically receive services from any doctor or hospital. However, not all healthcare provides will accept beneficiaries using a Medicare Advantage PFFS.4

Medicare Advantage SNPs – Medicare Advantage Special Needs Plans (SNP) only accept beneficiaries meeting certain eligibility criteria. There are three categories of plans: those serving people enrolled in both Medicare and Medicaid, those serving people living in institutions like a nursing home, and those serving people with particular chronic diseases like diabetes. The private insurance company adapts the plan in order to best meet the beneficiaries’ special needs. Like Medicare Advantage HMO Plans, you typically must receive your healthcare services within that plan's network.5

Medicare Advantage Plans 2014

The Department of Health and Human Services projected that enrollment in Medicare Advantage plans is expected to increase for the fourth straight year in 2014. Since the passage of the Affordable Care Act in 2010, average Medicare Advantage premiums have fallen by 9.8 percent. For 2014 the average Medicare Advantage premium is expected to increase just $1.64 from last year, to $32.60. For comparison the average monthly premium for a basic prescription drug plan (Medicare part D) in 2014 is projected to be $31. This is slightly higher than the average Medicare part D monthly premiums of $30 projected for 2011, 2012, and 2013.6

Over half of Medicare Advantage enrollees are enrolled in plans with CMS quality ratings of four or more stars on a scale from 1 to 5 (with 5 being the best).7 A HealthPocket study of 2014 Medicare Advantage plans found that plans rated at least 4 stars are available to residents in over half of U.S. counties. Another HealthPocket study found that 38% of star-rated 2014 Medicare Advantage plans had at least 4 stars, while only 28% of 2013 Medicare Advantage plans had at least 4 stars.

Analysis by the Kaiser Family Foundation found that on average beneficiaries can choose from 18 Medicare Advantage plans in 2014, down from 20 plans last year. According to the same study the average cap on out-of-pocket costs for 2014 Medicare Advantage plans is $4,797 in 2014, up from $4,333 in 2013.8 Since prices and coverage differ between Medicare Advantage plans within a state and can change annually, it is important to review your current plan as well as your other plan choices during Medicare’s annual enrollment period which spans from October 15th to December 7th.

How we can help

At Healthpocket, we provide you the tools to find Medicare Advantage coverage. We’ll help you find the right plan and save on your out of pocket Medicare Advantage costs:

  • Compare Medicare Advantage Plans (including those with Prescription Drug Coverage)
  • See Ratings & Reviews
  • Estimate Your Annual Out of Pocket Medicare Advantage Costs





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