Medicare vs.
Medicare Advantage
Medicare Advantage Plans (Part C) are increasingly popular with Medicare beneficiaries. According to enrollment trend data from CMS and research from the Kaiser Family Foundation, half of the Medicare population is enrolled in a Part C plan in 2023. What do these plans offer that might make them more attractive than Original Medicare or other health insurance options?
Original Medicare vs. Medicare Advantage Plan
Medicare Parts A and B (Original Medicare) offer only hospital and “medically necessary” healthcare coverage, a definition that excludes many health services that may be important to you. Medicare Advantage Plans cover everything included in Original Medicare and may also offer the following benefits:
- Vision: Annual exams, glasses, contacts, and additional tests
- Hearing: Exams and assistive devices
- Dental: Exams, cleanings, fillings, dentures, and more
- Fitness: Programs like SilverSneakers or RenewActive, with gym memberships, classes, and fitness apps
- Over-the-counter benefits: Buy supplies from the drugstore with money from your Medicare plan; covered supplies often include bandages, allergy medication, vitamins, supplements, and more.
Medicare Made Easy Part Three: Medicare Advantage Plans
Bundled Prescription Drug Coverage
While you’re on Medicare, you can be penalized for not having prescription drug coverage, although Original Medicare does not include that coverage. You can always enroll in a stand-alone Prescription Drug Plan (PDP) offered by a private insurance carrier. One advantage of Medicare Part C, however, is that many Medicare Advantage Plans also include prescription drug coverage. These plans are called Medicare Advantage Prescription Drug Plans (MAPDs).
Each plan will have a formulary explaining which medications are covered and at what costs. They will also explain which pharmacies are included in the plan’s network. You can still get your prescriptions at a different pharmacy, but you may pay more.
Low-Cost Premiums
According to a press release by CMS, the projected average premium for 2023 Medicare Advantage plans is $18 per month, which is 8% lower than in 2022. Many Medicare Advantage Plans are available with $0 premiums and some with $0 deductibles and copayments as well. It may be possible for you to get more benefits at no additional cost with a Medicare Advantage Plan.
You will continue to pay your regular Part B premiums while enrolled in a Medicare Advantage Plan.
Choice & Comparison
Medicare Advantage Plans are offered by many well-known insurance companies, probably the same ones you will recognize from your time on an employer insurance plan. These companies also offer multiple plans with different levels and types of coverage. As a result, Medicare beneficiaries have the luxury of comparing many options and choosing the plan that best fits them.
According to the Kaiser Family Foundation, a typical Medicare beneficiary will have 43 Medicare Advantage Plans to choose from.
Either independently or with the help of a licensed insurance agent, you can compare these plans and find the one that best fits your specific health and financial needs. Every year, Medicare evaluates plans based on a 5-star rating system. These 1 to 5 star ratings are based on a number of metrics that measure customer satisfaction.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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Further Reading:
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M