Medicare Advantage

Medicare Advantage Plans Explained

A Medicare-approved plan from a private company offers an alternative to Original Medicare, encompassing health and drug coverage. These "bundled" plans include Part A, Part B, and typically Part D. Note that Medicare Advantage plans are not considered supplemental coverage. Although these plans must provide the same benefits as Original Medicare (Parts A and B), each one can have varying out-of-pocket costs and rules for obtaining services. If you join an Advantage Plan, you still need to pay the Medicare Part B premium, which is $174.70 for 2024.

Pros and Cons of Medicare Advantage Plans

When you opt for a Medicare Advantage Plan, your primary coverage shifts to an insurance company rather than Medicare. These plans operate with networks (HMO or PPO), limiting the doctors and hospitals you can access. If you visit a provider outside the plan's network, you may incur all or a significant portion of the costs. Traveling doesn't necessarily put you out of network.

Advantage Plans are managed care plans, often requiring pre-authorization for many services and treatments, which could lead to delays or denials of care. These plans work best when you use in-network doctors and hospitals. Medicare Advantage plans function on a "pay as you go" basis, meaning the more you use the plan, the higher your out-of-pocket costs.