Why Medicare Advantage Plans Are Good

Are you considering your options for Medicare coverage? Medicare Advantage plans have become increasingly popular due to their comprehensive benefits and potential cost savings.

This article will help you explore the advantages of Medicare Advantage plans, how they compare to Original Medicare, and why Medicare Advantage plans are good, making them the right choice for you.


Key Takeaways

  • Medicare Advantage plans provide enhanced coverage beyond Original Medicare, including dental, vision, and hearing aid services as well as comprehensive prescription drug coverage.


  • The financial advantages of these plans include lower monthly premiums with out-of-pocket maximum protection and predictable co payments for easier budgeting.


  • Coordinated medical care is provided through primary care physicians along with additional wellness benefits such as gym memberships to improve overall health outcomes.

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Enhanced Coverage Beyond Original Medicare


Why Medicare Advantage Plans Are Good, Enhanced Coverage Beyond Original Medicare


Wouldn’t you appreciate a healthcare plan that exceeds the basic benefits of Original Medicare? That’s where Medicare Advantage plans come in. These plans, also known as Part C, provide enhanced coverage, including:

  • Dental


  • Vision


  • Hearing aids


  • Prescription drug coverage


  • Extra wellness benefits


In other words, Medicare Advantage plans bundle the benefits of Part A (hospital insurance), Part B (medical insurance), and often Part D (prescription drug coverage) into one comprehensive plan.

Medicare Advantage plans, with their comprehensive coverage packages, have emerged as a popular choice for individuals wanting a streamlined healthcare experience and additional benefits beyond Original Medicare.

Let’s analyze some of these extra coverage in detail.


Dental, Vision, and Hearing Aids

A significant advantage of Medicare Advantage plans is the inclusion of dental, vision, and hearing aid coverage. Original Medicare doesn’t cover routine dental care, but Medicare Advantage plans often provide coverage for cleanings, fillings, extractions, and dentures.

Similarly, routine vision services, such as eye exams and glasses or contacts, are generally covered under Medicare Advantage plans. When it comes to hearing aids, Medicare Advantage plans can provide coverage and help with costs, although the amount of coverage may vary depending on the plan.

Offering these extra benefits, Medicare Advantage plans contribute to your overall health and well-being, while Medicare supplement insurance can provide additional coverage options.


Prescription Drug Coverage Included

Medicare Advantage plans usually include Medicare drug coverage, known as Part D. This means you won’t need a separate Medicare drug plan to cover your medications.

Including prescription drug coverage, Medicare Advantage plans provide convenience, cost savings, and all-encompassing coverage.

The types of prescription drugs covered may vary depending on the plan, but in general, you can expect more inclusive prescription drug coverage when compared to standalone Part D plans.


Extra Wellness Benefits

Beyond dental, vision, and prescription drug coverage, Medicare Advantage plans frequently offer supplementary wellness benefits. These may include gym memberships, alternative therapies such as acupuncture or chiropractic care, and preventive services at no extra cost.

Offering these extra services, Medicare Advantage plans promote and support seniors’ overall health and well-being.

Financial Advantages: Understanding the Cost Savings


Why Medicare Advantage Plans Are Good, Financial Advantages: Understanding the Cost Savings


Beyond the extended coverage, the financial benefits are one of the main attractions of Medicare Advantage plans.

These plans often feature lower monthly premiums, out-of-pocket maximum protection, and predictable co payments. This can make Medicare Advantage plans more affordable for many beneficiaries.

For example, when visiting a primary care physician under Medicare Advantage, you may only incur a $10 co payment, whereas under Original Medicare, you could be subject to a 20% coinsurance, which could amount to more than $10.

This cost-sharing structure allows beneficiaries to better predict and manage their healthcare expenses, making Medicare Advantage plans an attractive option.


Lower Monthly Premiums

Lower monthly premiums are a standout feature of many Medicare Advantage plans. These premiums consider various factors, such as:

  • healthcare costs


  • provider networks


  • health status


  • healthcare use


As a result, Medicare Advantage plans can often provide more affordable coverage compared to Original Medicare.

Some popular Medicare Advantage plans with low monthly premiums include AARP/UnitedHealthcare, Humana, and Aetna. In fact, these are among the most Medicare Advantage plans chosen by beneficiaries.


Out-of-Pocket Maximum Protection

With out-of-pocket maximum protection, Medicare Advantage plans offer financial security by capping the amount you will pay in a year for covered services. The average out-of-pocket maximum for Medicare Advantage plans in 2023 is estimated to be $8,300, although plans may set lower limits.

Once you’ve reached this limit, your plan will cover 100% of the costs for covered services for the rest of the year, providing peace of mind in the face of unexpected medical expenses.


Predictable Co payments

Predictable co payments in Medicare Advantage plans are another financial benefit. Instead of paying a percentage of the total cost of services or medications, like with Original Medicare, you pay a fixed amount, called a co payment, for each service or prescription drug.

This makes it easier to budget for healthcare expenses, as you can anticipate the amount you need to pay for each service.

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Coordinated Medical Care


Why Medicare Advantage Plans Are Good, Coordinated Medical Care


Medicare Advantage plans provide coordinated medical care through primary care physicians, network efficiency, and preventive services at no extra cost.

This means that your healthcare is managed and organized by a primary care physician, who is responsible for coordinating care among different providers and stakeholders.

Coordinated health care ensures that you receive the right care at the right time, improving overall health outcomes and reducing the need for expensive hospitalizations or emergency room visits.


Role of Primary Care Physician

Primary care physicians play a central role in coordinating care within Medicare Advantage plans. They serve as the initial point of contact for most health issues, manage your overall healthcare, and refer you to specialists if necessary.

By having a primary care physician, Medicare Advantage beneficiaries can receive comprehensive and coordinated care, resulting in improved health outcomes and an enhanced overall treatment experience.


Network Efficiency

Network efficiency in Medicare Advantage plans helps to improve care coordination and potentially save costs. Here are some ways to achieve network efficiency in Medicare Advantage plans:

  • Provide adequate access to healthcare providers and services within the plan’s network.


  • Enable smooth communication and collaboration among providers.


  • Optimize administrative processes to streamline operations and reduce inefficiencies.


By implementing these strategies, Medicare Advantage plans can offer better care coordination and potential cost savings.


Preventive Services at No Extra Cost

Preventive services are often covered at no extra cost in Medicare Advantage plans, promoting overall health and well-being. These services include:

  • Exams


  • Shots


  • Lab tests


  • Screenings


  • Health monitoring programs


  • Counseling


  • Education


Providing these extra services, Medicare Advantage plans aid in preventing, identifying, or managing health risks and conditions.

Flexibility and Choice in Coverage

Why Medicare Advantage Plans Are Good, Flexibility and Choice in Coverage


Flexibility and choice in coverage are among the main advantages of Medicare Advantage plans. These plans come in different types, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs).

Each type of plan has its own unique features and benefits, allowing you to choose the one that best suits your needs and preferences.


Health Maintenance Organizations (HMOs)

HMOs are a common type of Medicare Advantage plan, offering:

  • A network of providers


  • Referrals for specialists


  • The requirement to use network providers for routine medical care.


  • The need for prior authorization to visit a specialist


While HMOs can provide lower out-of-pocket costs compared to other types of plans, they may limit your choice of healthcare providers due to network restrictions.


Preferred Provider Organizations (PPOs)

PPOs, on the other hand, offer more flexibility in provider choice but may have higher costs for out-of-network care.

You can receive care from both in-network and out-of-network providers, but you may incur higher out-of-pocket costs for out-of-network care.

PPOs generally do not require referrals for specialists, making it easier to access specialized care when needed.


Special Needs Plans (SNPs)

SNPs are designed for beneficiaries with specific health conditions or needs, providing tailored coverage and care. These plans specialize in providing targeted care and are limited to individuals with specific severe or disabling chronic conditions.

SNPs provided customized approaches and coordinated care to ensure beneficiaries receive the necessary services and support for their health conditions.


Seamless Plan Management


Why Medicare Advantage Plans Are Good, Seamless Plan Management


Seamless plan management is another advantage offered by Medicare Advantage plans. With one comprehensive plan, ease of handling claims, and support services, managing your healthcare coverage becomes simpler and more efficient.


One Comprehensive Plan

Medicare Advantage plans combine Parts A, B, and often D into one comprehensive plan, simplifying coverage.

This means that all your healthcare needs are covered under one plan, making it easier to understand and manage your coverage.


Ease of Handling Claims

Claims are typically easier to manage with Medicare Advantage plans, as they are handled by the private insurer. Here is how the process works:

  • When a healthcare service is received, the provider submits a claim to the insurance company for reimbursement.


  • The insurance company then reviews the claim to assess if it meets the plan’s coverage criteria.


  • If approved, the insurance company will then pay the provider directly for the covered services.


Support Services

Support services, such as care coordination and case management, may be available through Medicare Advantage plans.

These services can help ensure that you receive the appropriate care for your individual needs and can assist in managing complex medical conditions.

Nationwide and Emergency Coverage


Why Medicare Advantage Plans Are Good, Nationwide and Emergency Coverage


Medicare Advantage plans offer emergency coverage and urgently needed services nationwide, ensuring access to care when required.

This means that even if you’re traveling or temporarily away from your home area, you can still receive necessary medical services.


Covers Emergency Care Nationwide

Emergency care is covered nationwide in Medicare Advantage plans, ensuring beneficiaries have access to care when needed.

This includes hospital care, doctor visits, and emergency room visits at any hospital that accepts Medicare. However, you may be subject to deductibles and out-of-pocket costs associated with these services.


Urgently Needed Services Coverage

Urgently needed services are also covered in Medicare Advantage plans, providing care in non-emergency situations.

These services are provided when a member is temporarily outside the Medicare Advantage Plan’s service area or in extraordinary circumstances.

This ensures that you can receive the necessary care when you need it the most.

Enrollment Opportunities and Protections

Medicare Advantage plans provide enrollment opportunities and protections for Medicare Advantage enrollees, including the Medicare Open Enrollment Period, guaranteed acceptance, and the ability to transition between plans.

This ensures that you can choose the plan that best meets your healthcare needs and can make changes to your coverage if necessary.


Medicare Open Enrollment Period

The Medicare Open Enrollment Period allows beneficiaries to switch between Original Medicare and Medicare Advantage plans.

It typically occurs from October 15th to December 7th, during which time individuals can switch or join Medicare plans, alter prescription drug coverage, or make other changes to their Medicare coverage.

This period provides an opportunity to assess the features of Medicare plans available in your area and make modifications to your Medicare coverage that best suit your needs.


Guaranteed Acceptance

Medicare Advantage plans guarantee acceptance regardless of pre-existing conditions, ensuring access to coverage. Insurers are required to accept all eligible applicants, including those with pre-existing conditions.

This ensures that everyone can access comprehensive healthcare coverage through Medicare Advantage plans.


Transitioning Between Plans

Transitioning between plans is possible, but beneficiaries should be aware of potential limitations and restrictions. Generally, you can only change Medicare Advantage plans during the open enrollment period, which runs from October 15th to December 7th.

Before transitioning, you should meticulously review and compare different Medicare plans to ensure your healthcare needs are sufficiently covered.


In conclusion, Medicare Advantage plans offer a wide range of benefits, including enhanced coverage, financial advantages, coordinated medical care, flexibility and choice in coverage, seamless plan management, nationwide and emergency coverage, and enrollment opportunities and protections.

By understanding the various aspects of Medicare Advantage plans, you can make informed decisions about your healthcare coverage and ensure that you receive the care you need to maintain your health and well-being.


Frequently Asked Questions


→  Why would someone choose a Medicare Advantage plan?

Many people choose a Medicare Advantage plan due to extended benefits and the convenience of having medical, hospital, and prescription drug needs all covered under one plan.

Additionally, there may be low monthly premiums, along with coverage for services that Original Medicare doesn’t cover, such as fitness programs and some vision, hearing, and dental services.

Finally, these plans provide financial protection through a set annual out-of-pocket limit.


→  What is the downside of Medicare Advantage?

Medicare Advantage has downsides such as limited networks and prior authorizations for services, as well as a more limited choice of doctors and medical offices than Original Medicare.

Out-of-pocket costs may also be higher compared to those paid by Medigap enrollees.


→  What additional coverage options are typically included in Medicare Advantage plans?

Medicare Advantage plans typically include additional coverage options such as dental, vision, and hearing aid coverage.


→  What is the difference in cost-sharing between Medicare Advantage and Original Medicare?

Medicare Advantage may require lower out-of-pocket costs than Original Medicare, such as deductibles, copay, and coinsurance.


→  What is the role of primary care physicians in Medicare Advantage plans?

Primary care physicians play an essential role in providing coordinated care in Medicare Advantage plans. They are responsible for managing the patient’s overall health, monitoring any health risks, and referring them to specialists if needed.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.