(Updated Dec. 10)
The traditional late-year flurry of Medicare Advantage advertisements has hit televisions, websites, and social media platforms. You may have read MOAA’s first pass at the topic, but as with any complicated insurance matter, there’s always more to discuss.
Here are some additional Medicare Advantage consumer considerations as you shop for a Medicare plan.
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Understanding ‘$0 Premium Plans’
When you read or hear about a “$0 Premium Plan,” realize that you will pay your Part B premium regardless of whether you are under original Medicare or Medicare Advantage. All the “$0” means is that you do not pay above your Part B premium amount. Also, Advantage plans do not get you out of your higher Part B premium due to your higher income.
The $0 premium plans could have higher co-pays or co-insurance, higher deductibles, or a higher yearly maximum on your out-of-pocket costs for medical services. Or, the plan could be a Health Maintenance Organization (HMO) plan that requires you to go where they tell you go for service.
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The above additional cost factors are not usually a problem since TRICARE for Life (TFL) covers the residual costs as your Medicare supplement, just like it does under original Medicare.
Know Your Providers and Plans
Some independent medical providers may not accept Medicare advantage insurance plans. I always suggest you ask your current doctors which plans they prefer and use.
Advantage plans do not allow the use of Medicare Medigap supplement plans. This is not usually an issue for TRICARE for Life members, as TFL is your Medicare supplement and TFL members do not typically purchase Medigap supplements. But if you are a purchaser of a Medigap supplement, dropping your supplement to buy into an Advantage plan will cause problems later if you want to buy back into a Medigap plan in the future.
Technically, TFL supplements Advantage plans as it does Original Medicare since all are Parts A and B Medicare. However, TFL does not link with an Advantage plan in-system as Original Medicare does. This means claims will not flow automatically and seamlessly through the computer from Advantage plan to TFL as they do with Original Medicare.
You will probably have to file manual claims to TFL to have expenses that fall out of the Advantage plan reimbursed. You can call TFL to determine if coordination between TFL and an Advantage plan is possible by calling TFL at (866) 773-0404.
The final analysis for your coverage may be “If it ain’t broke, don’t fix it.” Unless you find greater coverage, less cost, and better service, you may not have reason to change from original Medicare.