What is a Medicare Advantage Plan?

Medicare Advantage is a term coined by the Medicare Modernization Act, enacted in 2004. It is used to describe the Medicare Part C programs that have been in existence since the late 1980s. When you hear the terms Medicare Part C, Medicare Plus Choice (the original name by the way), Medicare Replacement, or MAPD, know that they are all synonymous and not separate programs!

Here is a quick comment on the term Medicare Replacement: For many years this term was received cautiously, as some concluded it meant you were giving up your Medicare. This is not the case. What the term was trying to describe was that you are simply allowing private insurance companies to administer your Medicare entitlement program, where the carrier is fully responsible for providing benefits, paying claims, and enriching the plan through additional features and services.

Today, these plans are enjoying their highest rate of participation in over 30 years – thanks to a growing number of carriers and robust offering of plans in most of the 3,300 counties nationally. These plans have also demonstrated a higher quality of health outcomes by those participating on average, and, subsequently, have been strongly supported by the Medicare Trust Fund and those who legislate our healthcare nationally. Some have predicted that 50 percent of all Medicare beneficiaries will choose a Part C plan by 2030.



Medicare Advantage Plan is a Private Insurance Company’s version of Medicare

Simply put, A Medicare Advantage Plan is a Private Insurance Company’s version of Medicare. Most of the time it includes a Part D Drug plan, also originating from the 2004 MMA bill, and often has added benefits like Dental & Vision, as well as wellness initiatives like gym memberships, wellness rewards, over the counter allowances for the purchase of health related items, meals for those recently home from a hospital visit, and so on.

Each plan has its own summary of benefits, drug formulary, network of hospitals and physicians, and value enrichment programs. A Qualified Medicare Plan Advisor representing all major plans in your community and specializing in the Medicare market is a great source of guidance on understanding what each plan offers, and how to compare each to your personal needs and priorities.

Using a Qualified Medicare Plan Advisor costs you nothing. Agents are paid by the carriers for facilitated enrollments and commissions are regulated by CMS. So, each carrier pays relatively the same amount to avoid bias between plans. Furthermore, they not only serve as a great resource for selecting a plan initially, but are also helpful with any question, need, or challenge you may encounter with your plan – long after the plan becomes activated.

Good Qualified Advisors/Agents can assist with things like:

  • setting up a Silver Sneakers membership
  • helping a mail order Rx program
  • changing mode of premium payment, like checking accounts or social security deduction

Depending on your location, there are plenty of options to choose from when considering a Medicare Advantage plan for yourself, spouse, or loved one.

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