PMIA, Inc.----Phil Mattox, CSA, Pres.

Medicare Advantage plans---Pros and Cons

This imformation is so important that it is on every page of this site.  Go to the page titled Medicare Advantage Plans to learn the whole story. 

Now we come to a confusing part of this whole Medicare health plan situation.  Medicare Advantage Plans are not Medicare Supplements.  In my own words they are: Co-Pay Health Plans for Individuals on Medicare.  There are no age limits, young or old, everyone in the same county pay the same rate for the plans of their choice.  They only have one question and that is about End Stage Renal Failure.  You cannot apply for a Medicare Advantage Plan if you are End Stage.  Medicare has a great plan for those that are in End Stage.

The problem with Medicare Advantage Plans is that they do not have uniform benefits like the Medicare Supplements.  Rates may range form  -$20.00 $95.00 in many areas.  In Northwest Illinois we generally have those between $00.00 to $49.00.  One one statement that I think that I can trufully make is that you get what you pay for when you are on a Medicare Advantage Plan.  A Zero rate will generally mean that your co-pays for healthcare services will me much higher and your total out-of-pocket will be much higher that with a $49.00/month plan.

Let's review how an Advantage Plan works.  You still continue to pay your Part B premiums but Medicare will pay the Insurance Comapny to provide you with all services including all claims.  You are not giving up Medicare but choosing a different way of receiving those benefits. 

Each time that you receive healthcare services you will pay a co-pay except for those services that Medicare Provides free like flu shots.  You are actually gaining some added benefits like a Zero co-pay physical each year, perphaps some vision care as well as some hearing depanding upon the plan that you chooses.

There are some very important points that I want to make very clear to you when you are chosing a Medicare Advantage Plan. 

!. I have not see one that includes the Medicare Part D drug plan that was more advantages to you than buying the drug plan seperately.

2. Carefully consider the annual out of pocket maximum for co-pays that you would have to pay in any one year.  I know of one that has no limit on the co-pays.  You could pay 10-20% of all your claims for the year without limits.

3. Look at the hospital co-pay.  I have see everything from a single low co-pay for a stay in the hospital to up to $475 a day for a few days.  I encourage my clients to look at a single co-pay not a per day co-pay to more accurately predict their costs.  That hospital co-pay coverage all costs of the hospitalization including Dr's. fee and charges.

4. Look to see if there is a limit on the hosptial co-pays that you could pay during the year period.  The one I like has a limit of $600 for 2007 and for 2008.

5. Look at the list of co-pays for Dr., x-ray therapy, labs, misc outpaitient care.  These are important because the little things can eat you alive!!