A+B+D=C? Medicare Advantage; a deep dive

As an independent insurance agent that specializes in Medicare plans, I see people of all walks of life but the common theme is always people wanting to get the most out of their Medicare benefits.

Medicare Advantage plans are an extremely popular choice, and oftentimes an economical option. According to the Kaiser Family Foundation (KFF.org) enrollments in these Part C plans has doubled in the last 10 years. The popularity of these plans is pretty easy to see (well at least it is for me). Advantage plans roll your Part A hospital insurance, your Part B doctor/outpatient insurance and in many plans your Part D prescription drug coverage into one tidy package. Believe it or not, almost 60% of these plans won’t cost you anything above your Medicare Part B premium!

Here’s what my clients appreciate about Part C/Medicare Advantage plans:

  1. The premium; which can be as low as $0/month Notice that I’m not calling these plans “free”. That’s because you have to continue to pay your Part B premium to Medicare (which for most people is $148.50/month in 2021). $0 Premium means that the insurance company is not charging you an additional premium over and above Part B.

2. The Maximum Out of Pocket protection (M.O.O.P.)

This amount is often mistaken for a deductible but it’s actually a financial protection. All Advantage Plans are required to limit your copay spending on the medical portion of your coverage in a calendar year. When you are comparing plans, be sure to consider the max out of pocket in your decision making.

3. Prescription Drugs are included in many plans at no additional cost.

By having your prescription drug coverage included in your Part C plan you’re not only avoiding a penalty for not having drug coverage but you are able to take advantage of lower drug costs. Be sure to check to see if your prescriptions are covered and at what cost prior to enrolling.

4. No pre-existing conditions keep you from taking one. Advantage plans don’t

require medical underwriting. This means that you don’t have to answer health questions to determine if you qualify for the plan.

5. You don’t have to fall in love with your Advantage Plan for the rest of your life, just the rest of the year.

Advantage Plans are subject to change year-over-year just like your health and finances can. You can always re-evaluate your plan during the fall Medicare Annual Enrollment Period (AEP) which is October 15th through December 7th.

6. Variety! There are several types of Advantage Plans but the most common are HMO (in-network coverage only) and PPO which allows you to go out of network for a higher copay amount.

7. Extras!

Medicare Advantage plans must cover at a minimum all that Original Medicare does but can also offer lots of extras like routine vision coverage (exams and eyeglasses), dental coverage and even gym memberships and over-the-counter products.

I’ve said this before and it bears repeating; Medicare is not one-size-fits-all. What works for your healthcare coverage should be based on your individual health concerns and budget. Please keep in mind that Advantage Plan offerings vary by state and county so what’s available to you may not be the same offerings that your friends and family have in other parts of the country. For a complete list of Advantage Plan offerings in your county please go to https://www.medicare.gov/plan-compare or feel free to give me a call, my information is listed below.

Liz McPherson is an independent insurance agent that only sells Medicare plans and owns the Colorado Springs Medicare Resource Center. She lives in Woodland Park, Colorado with her husband, 4 dogs, 3 cats and a horse named “Dottie West”. She’s worked in the “Medicare world” since 2005 in both health plan operations and sales management. A proud graduate of Slippery Rock University (BA in Political Science) and University of Phoenix (MBA in Healthcare Management) she wears her nickname of “Medicare Nerd” as a badge of honor.

You can reach Liz at:



O: (719) 358-6696

C: (719) 243-0965 (text friendly)

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