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MEDICARE ADVANTAGE INSURANCE

MEDICARE ADVANTAGE

Medicare Advantage plans bundle Part A and Part B benefits, and some include prescription drug coverage.

Steve Turner
Insurance Specialist

Do I Need Medicare Advantage Insurance?

Medicare Advantage, or Part C or MA Plans, is a private company-offered health plan that provides an alternative to Original Medicare. Medicare Advantage Plans include Part A (Hospital Insurance), Part B (Medical Insurance), and typically Part D (Medicare prescription drug coverage).

When considering a Medicare Advantage plan, Medicare Supplement plan, or prescription drug plan, it’s essential to evaluate your healthcare needs and preferences.

Here’s how I can help. Before you enroll in a Medicare Advantage plan, I’ll do a complimentary needs analysis and carefully review the plan’s benefits and costs with you. There’s no obligation to buy anything. After our consultation, if you decide to choose me as your Agent, you won’t have to call an (800) number anymore. If you have questions, concerns, or issues about your Medicare Advantage plan throughout the year, you can contact me directly. 

HOW I CAN HELP YOU

KEY DETAILS

Benefits:

Medicare Advantage plans must cover all the services that Original Medicare (Parts A and B) covers. They may also offer additional benefits, such as prescription drug coverage, dental, vision, hearing services, and fitness programs.

Network:

Medicare Advantage plans typically have a network of doctors, hospitals, and other healthcare providers. You may be required to use providers in the plan’s network or pay more if you go out of network.

Cost:

Medicare Advantage plans may have different costs than Original Medicare. They may charge a monthly premium, and you may also pay out-of-pocket costs, such as deductibles, copayments, and coinsurance.

Enrollment:

You must be enrolled in Medicare Parts A and B to join a Medicare Advantage plan. You can enroll in a Medicare Advantage plan during certain times of the year, such as the Annual Enrollment Period (October 15 – December 7) or during a Special Enrollment Period if you have a qualifying life event.

Coverage:

 Medicare Advantage plans may have different rules for coverage than Original Medicare. For example, they may require prior authorization for certain services or treatments.

Advantages

Additional Benefits:

Medicare Advantage plans often include additional benefits beyond what is covered by Original Medicare, such as prescription drug coverage, vision, dental, and hearing coverage, and wellness programs. Some plans also offer transportation to your Doctor, Hospital (non-emergency) and Pharmacy as well as over-the-counter allowances for things like vitamins. 

Maximum-out-of-Pocket or (MOOP):

Most Medicare Advantage plans have an annual out-of-pocket maximum, which limits your total out-of-pocket expenses for the year.

For example, let’s say your Maximum-out-of-Pocket is $2,000 and you have a hospital bill that is $100,000. Your total cost for the year would be $2000 and your insurance company pays the rest as long as everything is in-network.

Network of Providers: Medicare Advantage plans have networks of providers, which may help you find providers more quickly and may result in lower costs.

Coordinated Care:

Medicare Advantage plans often provide coordinated care, which means that doctors, hospitals, and other healthcare providers work together to coordinate your care and ensure that you receive the right care at the right time.

Disadvantages

Network Limitations:

Medicare Advantage plans have networks of providers, which means that you may have to choose doctors and hospitals within the plan’s network. If you decide to see a provider outside of the network, you may have to pay higher out-of-pocket costs.

Prior Authorization:

Medicare Advantage plans may require prior authorization for specific treatments or services, which can delay or limit your access to care.

Cost-Sharing:

Medicare Advantage plans often require cost-sharing in the form of copayments, coinsurance, and deductibles, which can add up over time.

Plan Changes:

Medicare Advantage plans can change from year to year, which means that the benefits, premiums, and provider networks may change.

MEDICARE ADVANTAGE INSURANCE AGENT AND BROKER NEAR ME

As your Medicare Advantage Insurance Agent and Broker serving you, my goal is to “help you” and ensure, without a shadow of a doubt, that you and your family are secure and protected from risk. As a licensed Medicare Advantage agent, I take the burden off your shoulders by doing a thorough needs analysis and researching the benefits best suited to you and your needs.

I can help you save on severe medical emergencies and find a Medicare Advantage plan that offers low- to no-cost doctor visits, prescription medication, and extra benefits such as dental, vision and hearing, gym membership, and over-the-counter items. I will show you plans where your doctors are in-network and a side-by-side comparison of your prescription costs with the different plans.

Medicare is constantly changing, and I work tirelessly to stay informed about the latest developments in the market. Not a year goes by without new government regulations, new or modified coverages, and new techniques for controlling benefit costs. To best serve their clients, professionals must understand each type of benefit or program’s provisions, advantages, and limitations to meet economic security.

I am a long-standing National Association of Benefits and Insurance Professionals® (NABIP.ORG) member and hold the prestigious Registered Employee Benefits Consultant® designation (https://nabip.org/professional-development/rebc-designation). I can provide information on your market’s availability and any expected changes.

After you choose your Medicare Advantage Insurance plan, I provide ongoing support all year; you won’t have to call an (800) number any longer.

If you have any questions, issues, or concerns about your plan’s benefits, you can contact me via phone, text, or my simple-to-use email contact form using the buttons below.

EMAIL ME MOBILE / TEXT

MEDICARE ADVANTAGE FAQ

  • Long-term care.
  • Custodial care.
  • Most dental care.
  • Eye exams (for prescription glasses).
  • Dentures.
  • Most cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.
  • Concierge care (aka concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).
  • Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need).

As of 2024, there is no beneficiary cost sharing above the annual OOP threshold 2025. The coverage gap phase (also known as the “donut hole”) will be eliminated, resulting in standard Part D coverage consisting of a three-phase benefit: a deductible phase, an initial coverage phase, and a catastrophic phase.

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings).

In 2024, the out-of-pocket limit for Medicare Advantage plans may not exceed $8,850 for in-network services and $13,300 for in-network and out-of-network services combined. These out-of-pocket limits apply to Part A and B services only, and do not apply to Part D spending.

  • Mid-year enrollment notifications
  • Medicare Advantage plans must send policyholders a personalized notification between June 30 and July 31 of each year. This notification must include a list of unused supplemental benefits, the cost to claim them, and how to access them.
  • Outpatient behavioral health category
  • A new facility-specialty provider category will be added to ensure that Medicare Advantage enrollees have access to behavioral health providers. This category includes mental health counselors, marriage and family therapists, and more.
  • Administrative fees
  • Brokers and agents will no longer be able to receive administrative fees above Medicare’s fixed compensation caps.

  • Restrictive networks.
  • High out-of-pocket costs.
  • Prior authorization requirements.
  • Plans change each year.
  • Aggressive marketing and sales tactics.
  • Know your Medicare Insurance options.
  • Consider current and future needs.
  • Understand what the “worst” Medicare Advantage plan looks like for you.
  • Speak with an advisor.

The two-midnight presumption directs medical reviewers to select Original Fee-for-Service Medicare Part A claims for review under a presumption that hospital stays that span two midnights after an inpatient admission are reasonable and necessary Part A payment.

Many doctors and healthcare physicians don’t like Medicare Advantage plans due to coverage restrictions, limited networking, and overpayment rates, which cause increasing difficulties for patients.

You pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 premium and help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D).

Medicare Advantage (Part C): In 2024, the out-of-pocket maximum for Part C plans is $8,850 for approved services, but individual plans can set lower limits if they wish. Part D cost-sharing does not apply toward your Medicare Advantage plan’s MOOP.

Income-Related Monthly Adjustment Amounts (IRMAA) explained

  • Depending on your income, your monthly Medicare Part B or Part D premiums may be higher due to an Income-Related Monthly Adjustment Amount (IRMAA)
  • Part B IRMAA started in 2007 as a result of the Medicare Modernization Act of 2003
  • Part D IRMAA started in 2011 as a result of the Affordable Care Act of 2010

Eligible Income

  • Medicare defines the income used to determine IRMAA as “adjusted gross income plus any tax-exempt interest.”
  • Also known as Modified Adjusted Gross Income
  • Examples include:
  • Wages
  • Social Security Benefits
  • Capital Gains
  • Dividends & Pensions
  • Rental Income
  • Tax-deferred distributions from 401(k)s or IRAs

WHAT MY CLIENTS SAY ABOUT ME

QUESTIONS? CONTACT ME

I’m here to take your calls and emails and respond to your questions Monday through Friday from 9:00 a.m. to 5:00 p.m., excluding posted holidays.

CALL/TEXT: M-F 9-5

EMAIL ME: 24×7


OFFICE LOCATION

STEVE TURNER INSURANCE SPECIALIST

14502 N DALE MABRY HWY

SUITE 200

TAMPA, FL 33618

Medicare Annual Enrollment Period is Oct. 15th – Dec. 7th. Steve Turner is not connected with or endorsed by the United States Government or the Federal Medicare Program. Some plans may not be available in your area. Any information I provide is limited to plans offered in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all of your options.