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Home/Advocacy/Medicare Advantage Q & A: Unbiased Answers from a Michigan Nonprofit

Medicare Advantage Q & A: Unbiased Answers from a Michigan Nonprofit

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The window is open for Medicare beneficiaries to sign up for a different Medicare Advantage plan or switch back to Original Medicare (Parts A and B) and select a prescription drug plan (Part D). The enrollment period goes through March 31.

The Area Agency on Aging 1-B’s Medicare Medicaid Assistance Program (MMAP) has certified counselors who can help you explore your options and enroll in a Medicare Advantage plan that works for your health care needs and budget. They are not affiliated with any insurance company and do not favor one plan over another.

Medicare Advantage is an “all-in-one” alternative to Original Medicare (Parts A and B). These plans combine Medicare Parts A, B and usually D (prescription drug coverage). Their copays and premiums vary, but they all cap out-of-pocket costs. Medicare Advantage plans may offer extras like fitness, vision, dental and hearing benefits.

Shari Smith, manager of MMAP, explains some of the advantages and disadvantages of these plans:

What are the advantages of a Medicare Advantage plan?

Medicare Advantage plans offer the convenience of carrying a single Medicare card. It may be less expensive than buying a separate prescription drug plan (Part D). Most of these plans include vision, hearing and/or dental benefits, which are not including in Medicare Parts A and B (although there may be an additional cost for them).

Are there premiums attached to Medicare Advantage plans?

Not for all plans. You still have to pay for the Part B premium, or $148.50 this year [that’s the standard premium. If you fall into a higher income bracket, you’ll pay more].

What is the range of monthly premiums for a Medicare Advantage plan?

$0 to $299.

What are some disadvantages of a Medicare Advantage plan?

Many of these plans require you to choose a primary care doctor in the plan’s network, so you may not be able to stay with the provider of your choice.

Also, many Medicare Advantage plans require you to take extra steps to get what you need. For example, some plans require a referral from your primary care provider if you want to see a specialist.

With Medicare Advantage, one of the pitfalls is estimating your true out-of-pocket costs. That’s something we can help with.

What should consumers look for if they are considering buying a Medicare Advantage plan?

Beneficiaries should get a good estimate of what their true out-of-pocket costs will be, including premiums. They should look at the co-pays, co-insurance and deductibles and whether extras are included in the plan or cost more (a fitness benefit might cost another $50 per month, a vision benefit might include only a yearly eye exam and not prescription lenses, a dental benefit might include a cleaning and X-rays but no coverage for crowns, for example). You’ve got to read the fine print.

They should ask if all their doctors are in the plan’s network and if all their prescription medicines are covered by the plan’s formulary. Additionally, beneficiaries should be aware that they cannot keep their Medigap (subsidy) policy if they join a Medicare Advantage plan.

What can consumers do between Jan. 1 and March 31?

You can change your Medicare Advantage plan or switch from a Medicare Advantage plan to Original Medicare (Parts A and B), but not the other way around.

You may also wait until the Medicare annual enrollment period from Oct. 15 to Dec 7, 2021, to do the same. However, new enrollees may switch to Original Medicare within 12 months if they are unhappy with the plan.

If you just became eligible for Medicare, can you buy a Medicare Advantage plan?

Yes.  Anyone who is new to Medicare can enroll in a Medicare Advantage plan.

What has changed in Medicare Advantage plans in 2021?

Insulin with some plans may be available at $35 a month.  Also, people with End-Stage Renal Disease are now able to enroll in a Medicare Advantage plan.

How many Medicare Advantage plans are on the market?

There are more than 50 available in our service region (Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw counties). 

How Can You Get More Help?

Call our Medicare Medicaid Assistance Program at 800-803-7174 for a free, confidential appointment with a certified counselor. He or she can go over different plans, discuss how you like to access health care, review your medications and more to help you decide the best plan for you.

If there is no answer, leave a message in our callback system and you will receive a response within a few days. Please leave details so we can help you faster.

You can also visit our Medicare & Medicaid Help page for more help with Medicare, including programs for lower-income beneficiaries like the Medicare Savings Program to help with Medicare Part B expenses or the Extra Help Program to help with prescription costs.

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