Medicare Advantage Plans

Medicare Advantage is the broad name for private plans that contract with the Federal Agency, Centers for Medicare and Medicaid Services (CMS), and includes a variety of different coordinated/managed care and private fee-for-service organizations. These plans offer both health insurance and optional drug coverage benefits called Medicare Advantage Prescription Drug Plans (MAPDs).

History of MA Plans - The Balanced Budget Act of 1997 allowed for a new set of options for filling the gaps in Medicare Coverage. The program was called "Medicare+Choice (M+C) or Medicare Part C. The MA health plan contracts with Medicare and receives a fixed monthly payment for for each enrolled beneficiary. The Medicare Prescription Drug Improvement Act of 2003 improved on the M+C by increasing benefits and payments to the providers. At that time the name changed from M+C to Medicare Advantage (MA). In 2006, new regional plans were made available.

What MA Plans Do - The MA must provide Medicare-Covered services. These plans may also provide additional services that can include: prescription drugs, routine physical exams, hearing aids eyeglasses and basic dental.

With Medicare Advantage plans the government pays a fixed amount of money to the private plan to provide all medically necessary treatment covered by Medicare. Generally, plan members must obtain services from health care providers who are part of the specific plan. The MA functions as both the insurer and health care provider. Most Medicare beneficiaries can choose to receive benefits either through the Original Medicare program, or through one of the following plan types:

                1) Health Maintenance Organization (HMO)
                2) HMO with Point-of-Service (POS) option
                3) Preferred Provider Organization (PPO)
                4) Private Fee-For-Service (PFFS)
                5) Special Needs Plan (SNP)
                6) Other options such as employer- and union-sponsored group
                     plans or VA benefits

Why MA Plans may be of Benefit? - Medicare does not pay all of the health care expenses. The expenses that Medicare does not pay include: deductibles, co-payments, routine checkups and other services not covered.

How to Join an MA - To join a MA Plan you must have Medicare Part A and Part B. You must pay your monthly Medicare Part B premium to Medicare. In addition, you will need to pay a monthly premium to your Medicare Advantage Plan for the additional benefits. If you join a MA Plan, your Medigap Plan will not work! While you have a legal right to keep the Medigap Plan, you may want to drop the plan. MAs generally cost less than Medigap Plans and are able to provide more benefits for a smaller premium due to the utilization of cost controls and provider contracts.

Carrier/Providers Offering Medicare Advantage Plans Include:

               Advantra Freedom Plan (Coventry) - www.advantrafreedom.com
               Aetna - www.aetnamedicare.com
               Anthem - www.anthem4seniors.com
               Blue Cross/Blue Shield - www.bcbs.com
               Cigna - www.cignamedicare.com
               Evecare - www.evecarehealthplans.com
                   Freedom Health - www.freedomh.com/medicare.html
                   Humana - www.humana-medicare.com
                   Kaiser - www.kaiserpermanente.org/medicare
                   Secure Horizons (UnitedHealthCare) - www.securehorizons.com
                   SummaCare - www.medicare.summacare.com
                   Unicare - www.unicare.com