What Is Medicare Advantage? Is It Better Than Regular Medicare?

What is Medicare Advantage, and should I enroll in it? Is regular Medicare coverage just as good? What are the differences? Medicare Part C is the portion of Medicare that covers Medicare Advantage programs. This article will try to explain it in layman's terms, ignoring the complex and concentrating on the practical. Many do not understand the different options that seniors have offered to them, so I will try to make this as simple as possible. Medicare Advantage, for the patient, can be a welcome alternative to traditional Medicare, but it does have some problems. It is not perfect and does cost more money for the government to offer.

The federal government pays private insurance companies over $1,000 per year for each of the 11 million current enrollees. This payment is over and above the normal costs of Medicare that are paid to the companies. It is a bonus, if you will. Eleven billion dollars per year is a pretty big bonus. What do seniors get for the bonus? Depending on the plan they enroll in, they can get plenty! Some plans offer dental coverage, comprehensive vision coverage, acupuncture and chiropractic services, while still others offer gym memberships. In other cases, not so much. The cost of Medicare Advantage to the beneficiary is generally less than traditional Medicare coverage. Instead of the usual 80/20 split as in Medicare Part B (outpatient services), there is often a $5.00 to $20.00 copay for office visits. That alone usually saves money.

Most of the 11 million Advantage enrollees are covered under HMO plans. The plans mirror those offered on the commercial market. Secure Horizons, Kaiser Advantage, Scan are just a few of the plans in existence. Once enrolled, a Medicare recipient has no need to buy a supplemental insurance policy.

In order to enroll in a Medicare Advantage plan, the beneficiary must first enroll in Medicare Part A, Part B and Part D. Once that enrollment is complete, enrollment in a Medicare Advantage plan is possible.

Since these plans are generally mirror images of the commercial products, the problems are the same, or can be. Depending upon the choice of network and primary care physician, authorizations can take time. In virtually all cases, the primary care physician is the gatekeeper. He or she will determine what specialists are seen and he or she will also coordinate what testing is done. The Medicare recipient also gives up the right to see any or all of the doctors they choose. Their complete care regimen is controlled by their primary care physician.

With Medicare Advantage, you cannot go to doctor after doctor for the same problem. You will not be getting a CT scan ordered by each doctor you see. Your care will be highly coordinated and utilization will be monitored.

With the Ryan budget plan, now the GOP budget plan, being adopted by the entire right side of the aisle, Medicare Advantage programs come front and center. They are run by private insurance companies, and although President Obama has been accused by the GOP and others who are uninformed of cutting $500 Billion dollars from Medicare, those cuts came mostly from attempts to rein in and discontinue the government bonuses paid to private insurers for Medicare Advantage. None of that $500 Billion dollars came from cuts to services covered by the original Medicare plan. You may have heard different, but what you heard was a lie!

Perhaps the most clearly written explanation of the cuts in the Affordable Health Care Act come from another hubber on this site: Deni Edwards. The link to her comprehensive article is: http://hubpages.com/hub/healthcarereformandmedicarecutsandbenefits .

It is a great article and should be read by all!

Finally, if I was a Medicare-eligible senior, I would enroll in a Medicare Advantage program in a hot minute. It would save me money. BUT, and that is a capital BUT, I have worked my entire life in the health care field. I know which plans are good and I also know my way around the private insurance maze. I know how to fight delays in authorizations; I know how to fight claims denials. I do not consider myself a lay person.