Medicare Advantage Plans
Medicare Advantage Plans, also referred to as Medicare Part C, are required to provide the same benefits as Medicare Part A and B but are allowed to offer additional benefits. With original Medicare Part B, Part B covers 80% and you are responsible for 20%. Medicare Part C plans use a flat copay amount instead of 20%, so clients know how much the services with cost ahead of time, instead of being told they owe 20%. Medicare Part C plans are offered by private companies like UnitedHealthcare, Humana etc. Most Part C plans also include drug coverage (Part D), and are usually zero premium.
Medicare Advantage Plans: (HMO)
- Must use a Doctor In-Network
- Requires a referral from your Primary Care Physician (PCP) to see a Specialist
- Emergency Room Only Coverage, outside of your service area. (While traveling or on vacation)
- All Plans are rated on a 1 to 5 Star Rating
- Plan eligibility is based on County of Residence
- Each plan is different / no nationwide consistency
- Plans vary between Advantage Plan providers
- Plans vary within the same Provider, from city to c
- Silver Sneakers included with Humana- RenewActive included with UnitedHealthcare Plans –
- Accepted at 24 HR Fitness, L.A. Fitness, YMCA, Curves, Golds Gym, Local Recreation Centers, and many others nationwide
Key Factors of any Advantage Plan
- Premium – Typically $0 in large markets
- MOP (Max out of Pocket) – Maximum Amount of Co-Pays Per Year: NOT a deductible!
- Range from $2800 to $6700 ($6700 Max allowable by Law)
- Co-Pays (amount paid for specific services):
- Standard Co-Pays:
- PCP – $0 to $30 Per Visit
- Specialist – $30-$60 Per Visit
- Hospital – Amount per Day (typically $200-$350 Per Day)
- 5-7 Days Max, typically
- Days 7-100 = $0 Co-Pay
- Example: $250 Day x 6 days = $1500 Max Co-Pay for Hospital stay.
- Days 7-100 – $0 Co-Pay
- Usually includes Vision and Hearing coverage (Medicare does NOT cover)
- Other Co-Pays exist, however the above is the most common
- Standard Co-Pays:
- Network Size- How many doctors in your area that accept UnitedHealthcare or Humana
Blue Sky Medicare offers 2021 UnitedHealthcare and Humana Medicare Advantage Plans in the red states listed below.
The Plan is zero premium Medicare Advantage Plan WITHOUT Part D drug coverage, ideal for clients who have Part D already (TriCare for Life), but want additional benefits.
Humana offers the Honor plan for residents of most of the country.
Humana plan will NOT result in you losing your Tri Care for Life coverage, but you must be enrolled in Medicare Parts A and B. Call Steve at 303-501-3125.
Medicare Advantage Plans are available in other parts of these states, from other insurance companies, which I do not represent.
Medicare Advantage Plans are regulated by CMS, Center for Medicare and Medicaid Services. Therefore, the above information is as specific as I am permitted to share, however, I would be happy to discuss the details of Medicare Advantage Plans in your area and email you the enrollment guide with all the plan copays etc.
Steve Schrader- 303-501-3125
History of Medicare Advantage Plans:
- 1997 – Medicare Choice Plus introduced
- 2003 – Renamed Advantage Plan
- 2005 – 5 Million people on Advantage Plans nationwide
- 2020 – 23 Million people on Advantage Plans nationwide