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If you're reading this, it's probably because you know about Medicare supplements but keep hearing about Medicare Advantage plans and wondering whether they're legitimate. I assure you, they are legitimate, they're just a different way for you to protect yourself. For those of you who are used to purchasing health insurance through your employer's group health plan, these plans will seem very familiar.
Let me answer the main concerns I've heard regarding Medicare Advantage plans.
What's Medicare Advantage?
Basically, it's the government outsourcing Medicare duties, such as administration and claims processing, to private insurance companies. A Medicare Advantage plan can take three forms: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Private-Fee-For-Service (PFFS) plans. HMOs and PPOs are similar in that both are managed care systems based on contractual agreements between providers (hospitals and/or doctors) and insurance companies. The difference between the two is PPOs will allow you to go outside their network, but make you pay more of the bill.
PFFS plans are different; they're also what most people are talking about when they ask about Medicare Advantage plans.
Here's how they work: Medicare contracts with private insurance companies and pays them a "subsidy" to take care of seniors in a specific geographic area. For example, let us say that it costs Medicare $100 per senior to administer Medicare in Berks County in Pennsylvania. Medicare contracts with a private insurance company and says it will pay the company $75 per senior in Berks County to administer Medicare and pay all claims coming from those seniors. The catch is that the insurance company must provide everything Medicare covers plus extra benefits. Everybody wins here. Medicare saves money, the insurance company receives more clients and the policy holder pays less for more benefits.
How much do I have to pay?
It's tough to say. Most of the more than 200 companies that contract with Medicare have some sort of $0 premium plan in their arsenal. Most Medicare Advantage plans are less than $100 per month, which is a lot less than the average Medicare supplement. So far, premiums have remained flat compared to the rising costs of Medicare supplements, but I don't expect that to last very long, especially with the $0 premium plans.
What do I get out of it?
Besides the lower premium you usually get more benefits than you
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