Why is Medicare Advantage Important? A Look at the Key Benefits

Medicare Advantage plans play a valuable role in expanding coverage beyond Original Medicare. Learn about the extra services and cost savings that make Medicare Advantage an important option for many.

What is Medicare Advantage?

Medicare Advantage (MA), sometimes called Medicare Part C, refers to private insurance plans that provide Medicare Part A and Part B benefits. These plans have contracts with Medicare to provide coverage to beneficiaries.

Some types of Medicare Advantage plans include:

  • HMOs (health maintenance organizations)
  • PPOs (preferred provider organizations)
  • PFFS (private fee-for-service)

Key features of Medicare Advantage:

  • Offered by private insurers approved by Medicare
  • Include all Part A and Part B coverage
  • Often include prescription drug coverage
  • May offer extra benefits beyond Original Medicare

Medicare Advantage provides an alternate way to get standard Medicare benefits through private health plans. Many people find the extra coverage and convenience appealing.

Why Consider Medicare Advantage?

There are several important reasons Medicare Advantage plans are worth considering:

Lower Out-of-Pocket Costs

Many Medicare Advantage plans have $0 premiums or low monthly premiums compared to Medigap plans. This can provide significant savings for beneficiaries.

Most MA plans also cap your annual out-of-pocket spending. Once you hit that limit, the plan covers 100% of costs. Original Medicare has no cap, exposing you to unlimited expenses.

Extra Benefits and Perks

Medicare Advantage plans frequently include valuable benefits Original Medicare doesn’t cover:

  • Vision – Exams, glasses, contacts
  • Hearing – Hearing aids, exams
  • Dental – Cleanings, x-rays, certain procedures
  • Fitness – Gym memberships, activity trackers
  • OTC medications – Up to $100 or more per month
  • Transportation – To doctor appointments
  • Meal delivery – After hospital stays

These can represent hundreds of dollars in annual savings on healthcare costs.

Coordinated Care Approach

Many Medicare Advantage plans require you to have a primary care doctor and get referrals to see specialists. This helps coordinate your care more seamlessly.

Your PCP can view your entire medical history, avoid duplicate services, and ensure you get recommended preventive screenings.

Innovative Programs for Chronic Conditions

Some Medicare Advantage plans offer special programs for members with certain chronic illnesses like diabetes or COPD. These provide customized services to help manage the condition.

Programs may include regular provider visits, home monitoring devices, medication delivery, gym memberships, and other support tailored to the disease. This facilitates better outcomes.

Providers Under One Plan

Rather than juggling separate Part D, Medigap, and Medicare providers, many people appreciate having all their coverage through one MA plan.

Seeing in-network doctors for lower copays and having a unified deductible is simpler than navigating multiple plans.

Medicare Advantage vs. Medigap

How does Medicare Advantage stack up against Medigap supplemental plans?

Medicare Advantage Medigap
Cost $0 – low premiums Higher premiums
Prescription Drugs Usually included Must buy separate Part D plan
Extra Benefits Often included None beyond Medicare coverage
Provider Network Yes Can see any provider
Out-of-Pocket Max Yes No, except Plan G
Travel Coverage Varies by plan Covered nationwide

As the comparison shows, Medicare Advantage often provides more value at a lower monthly cost. But Medigap allows unrestricted provider choice.

When is Medicare Advantage a Good Option?

Medicare Advantage offers advantages for many beneficiaries, including:

  • Healthy people who rarely need medical services
  • Those wanting basic care + extra benefits
  • People with chronic conditions needing coordinated care
  • Those who travel frequently and want national coverage
  • Individuals looking to minimize healthcare expenses

Review your situation carefully to decide if an MA plan could be beneficial and affordable for you.

Key Considerations Before Enrolling

While Medicare Advantage offers appealing benefits, weigh these factors before signing up:

  • Verify your doctors and hospitals are in-network or you may have to switch providers.

  • Ensure any medications you take are covered on the plan’s formulary.

  • Check that you can access emergency and urgent care when traveling if the plan is regional.

  • Understand the annual out-of-pocket costs you’ll be responsible for.

  • Know the penalties for going out-of-network or getting non-approved services.

Doing your homework is key to avoiding surprises. An insurance broker can explain policies in detail.

The Takeaway

Traditional Medicare vs. Medicare Advantage Explained


What is the point of a Medicare Advantage Plan?

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA” Plans, are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

Why would someone choose Medicare Advantage?

Medicare Advantage plans cover all the same services under Original Medicare Part A and Part B, but often include prescription drug coverage and extra benefits. Some benefits may provide coverage for: Routine dental care (dental exams, X-rays, teeth cleanings)

Why is everyone pushing Medicare Advantage plans?

The main reason for all the marketing is the money made by private insurers. Just over half of Medicare beneficiaries are enrolled in Medicare Advantage plans, with under half choosing traditional Medicare.

Why do people join Medicare Advantage?

People with Medicare are drawn to Medicare Advantage for the extra benefits. Medicare Advantage plans offer extra benefits, like reduced cost-sharing, dental coverage, gym memberships and debit cards for over-the-counter medical supplies that are not covered by traditional Medicare.

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