Medicare Advantage

You've probably seen the commercials - happy seniors talking about all the "free" benefits they get with Medicare Advantage. No monthly premium! Dental coverage! Vision benefits! Even grocery allowances! It sounds almost too good to be true.

Well, sometimes it is too good to be true. And sometimes it's exactly what you need. The trick is figuring out which situation you're in.

What Medicare Advantage Actually Is

Think of Medicare Advantage (also called Part C) as a replacement for Original Medicare. Instead of the government running your Medicare benefits, you're signing up with a private insurance company that contracts with Medicare to provide your coverage.

These companies get paid a set amount by Medicare for each person they cover, and they use that money to provide your Medicare benefits plus usually some extras. If they can do it for less than Medicare pays them, they pocket the difference. If it costs more, they eat the loss.

Why Companies Can Offer "Free" Benefits

Here's the thing about those extra benefits: they're not actually free. Medicare pays these companies more than what Original Medicare typically costs, specifically so they can offer additional benefits to attract members.

The companies also save money by managing your care more tightly - requiring prior authorizations, limiting networks, and steering you toward lower-cost providers. That's not necessarily bad, but it's how they can afford to offer things Original Medicare doesn't cover.

The Good Stuff About Medicare Advantage

Often includes prescription drug coverage: Most Medicare Advantage plans include Part D drug coverage, so you don't need a separate prescription plan.

Extra benefits: Dental, vision, hearing aids, wellness programs, transportation to appointments, even grocery allowances or gym memberships.

Out-of-pocket maximums: Unlike Original Medicare, Medicare Advantage plans have caps on how much you'll pay per year for covered services.

Lower monthly costs: Many plans have $0 premiums, though you still pay your Medicare Part B premium.

Coordinated care: Your medical care is managed through one plan, which can mean better coordination between your doctors.

The Not-So-Good Stuff

Network restrictions: You're generally limited to the plan's network of doctors and hospitals. Go out-of-network and you might pay a lot more or get no coverage at all.

Prior authorizations: The plan might require approval before you can get certain treatments, procedures, or see specialists.

Annual changes: Plans can change their benefits, drug coverage, doctor networks, and costs every year. What's covered this year might not be next year.

Geographic limitations: If you travel a lot or spend time in different states, you might have coverage issues outside your plan's service area.

Less predictable costs: While there's an out-of-pocket maximum, your actual costs can vary widely depending on what care you need.

Who Should Consider Medicare Advantage?

You're generally healthy and don't see a lot of specialists or need many prescriptions.

You want predictable, lower monthly costs and are okay with some restrictions on where you can get care.

You value the extra benefits like dental, vision, or wellness programs that Original Medicare doesn't cover.

You don't travel much or can work within the plan's coverage area.

You're comfortable with managed care and don't mind getting referrals or prior authorizations.

Who Might Want to Stick with Original Medicare?

You have complex health conditions or see multiple specialists who might not all be in one plan's network.

You travel frequently or split time between different states.

You want the freedom to see any doctor who accepts Medicare without referrals or network restrictions.

You're willing to pay more monthly (for a Medigap policy) in exchange for more predictable costs and fewer restrictions.

The Questions You Should Ask About Any Medicare Advantage Plan

• Are my current doctors and hospital in the network?

• Are my prescriptions covered, and what will they cost?

• What's the out-of-pocket maximum, and what counts toward it?

• What happens if I need care while traveling?

• How do I get approval for specialists or procedures?

• What extra benefits do I actually need and want?

• Can I afford the potential out-of-pocket costs if I get seriously ill?

How I Can Help You Decide

Medicare Advantage isn't right for everyone, but it's a great choice for many people. The key is understanding what you're getting and what you're giving up.

I can help you:

• Compare Medicare Advantage plans in your area

• Understand the real costs, not just the premiums

• Check if your doctors and prescriptions are covered

• Figure out if the trade-offs make sense for your situation

• Time your enrollment to avoid gaps in coverage