4-52 Medicare@Work for Employees Turning 65 -Medicare Stew

Medicare Stew – Part 3 – What is a Medicare Advantage Plan- Part C

The Medicare Stew Series continues with another helping of some basic Medicare information to help your employees. 

Today, learn about Medicare Advantage Plans – sometimes called “Part C” or “MA Plans,” which are offered by private companies approved by Medicare. 

MA plans are another coverage option for folks eligible for Medicare. These all-in-one plans contract with Medicare and must follow the same rules that Medicare sets for coverage. They combine the benefits of Parts A & B and sometimes Part D. When you select an MA plan, it becomes your primary insurance. An insurance company manages the plan. After enrolling in Parts A and B (Original Medicare) of Medicare (yes, you still need to do that), if you select an MA plan, the issuing insurance company sends you a benefits card to use for all of your healthcare (doctors, hospital services, and sometimes medications). They will manage your benefit as long as you continue on their plan. Even though you are still in a Medicare program, you no longer use your Medicare card for your medical services.

Additional Benefits

These plans are steadily growing in popularity because they can also include things Original Medicare doesn’t. For example, when replacing an employer group plan, retirees like the fact that MA plans might include coverage for dental, vision, hearing, fitness, transportation to doctor visits, and even coverage or discounts for over-the-counter items.  So these plans are full of additional benefits similar to the group plans they are used to under their employer.

Some MA plans tailor their coverage to manage certain chronic medical conditions, like diabetes. The coverage under these plans helps patients stay compliant with their treatment plans to stay healthier. These plans can offer cost savings advantages they may not have enjoyed on their group plans for people with chronic conditions.

Oh, and anyone who is eligible for Medicare can get an MA plan. Rarely is medical underwriting an issue and you can switch MA plans during certain times of the year.

Networks

Most MA plans offered are network-based and can be either HMO or PPO-based. That means if you want to keep your current doctors, you will need to find a plan with a network your doctors participate in.  Also, many plans have their own rules about coverage and could require a referral to see a network specialist, although as of 2022, this requirement is less mandatory. Note: Doctors can leave plan networks every year, so it’s essential to review your MA plan during Medicare’s Annual Enrollment (from Oct 14- Dec 7) to ensure your doctor will still be in the plan’s network for the coming year. MA plans are not offered in all areas, so these plans are not an option for folks living outside of certain areas.

Costs

Premiums, copays, and out-of-pocket costs will differ on each plan and change annually. You still pay for Part B and any additional premium for your MA plan. So, just like choices for prescription drug plans, it will be important to make sure whatever MA plan you choose has costs you can afford, your doctors, preferred pharmacy, and hospital in the network when you first choose and annually thereafter.

Drug coverage is often included with MA plans but can differ in how your prescription drugs will be covered. So besides making sure your providers are in-network, you need to research all of your prescriptions costs on each plan as well. Some pharmacies will be preferred to use and will keep your prescription costs lower.

Help for Employees/Retirees 

Determining whether to enroll in Original Medicare or a Medicare Advantage plan depends on a person’s specific needs. When it comes to Medicare, one size does not fit all!  There are LOTS of options for coverage.

Having a dedicated team to help employees sort through all the choices, help them do the math, and research to find a plan that is appropriate can make transitioning from a group plan so much simpler. We are here to help!

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– Lora