FAQ Friday: What is a Medicare Advantage Plan?

A Medicare Advantage Plan is not a Supplement Plan, it is a private alternative to Medicare. A Medicare Advantage Plan will not pay the bills that Medicare would normally pay, instead a Medicare Advantage Plan will charge you a different deductible, different copays and different co-insurance compared to Medicare.

Medicare Advantage Plan Summary:

  • Low monthly premium. (Sometimes advertised as $0.00 per month)
  • You will usually have to pay a fee every time you use the plan. ($15.00 copay for PCP visit, $300.00 per day each day you are in the hospital, etc.)
  • You have to go to certain Doctors, Hospitals and Providers. (HMO or PPO Network)
  • You will have to get prior authorizations for some procedures.
  • You will have to get referrals to go see a specialist.

A Medicare Supplement Plan will be the best coverage you have ever had in your life. If you go to the hospital your Medicare Supplement Plan will pay the $1,316.00 that Medicare does not pay. When you go to the Doctor, get lab work or even a surgery – Medicare will pay 80% and your Medicare Supplement Plan will pay the other 20%.

With a Medicare Supplement Plan, you will pay more per month but you are paying for:

  • Flexibility – You can go to any Doctor that accepts Medicare and you do not have to get prior authorizations for procedures.
  • Predictability – You know that as long as you pay your monthly premium, you will rarely have a bill that you have to pay. (My favorite Medicare Supplement Plan is G. With Plan G, all you pay is the Part B Deductible of $183.00)

So which type of coverage is best for you? 

Ask yourself this question: “If I chose a Medicare Supplement Plan, and I pay $120.00 per month, and I have a good year with my health, let’s say I didn’t really use the Supplement Plan that much – Would I consider that $120.00 per month a waste of money or because I am 65 or older, and I am more likely to use my health insurance in the next 5 years compared to the last 5 years, the $120.00 per month is a cost of living?”