Advantage Plans also known as Medicare Part C or All-In-One-Plans
Advantage Plans are a replacement alternative plan to Original Medicare offered by private insurance companies that contract with Medicare to provide you with your Part A and Part B benefits. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans bundle prescription drug coverage within the Advantage Plan.
| Original Medicare: | Advantage Plans |
| No Networks:
Open Access, go to any Provider, Doctor, Specialist, Hospital or Facility throughout the U.S. who accept Original Medicare and most do. |
Networks:
Must obtain care from an ever changing, often narrow, limited, restricted network of providers for coverage. (Urgent & emergency situations are exceptions.) |
| Rarely does a provider stop accepting Original Medicare. (Per: Kaiser Family Foundation only 1% of doctors do not accept Original Medicare)
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Medicare Advantage Plans can add or remove providers from its provider network at any time during the year. If your Doctor is removed from your Advantage Plan Network you will need to find a new Doctor in network for coverage. |
| No Prior Authorizations:
No prior authorizations required. Your Doctor is free to decide whether you should have a test or procedure done without restrictions or limitations from an Insurance Company. |
Prior Authorizations Required:
Required for many tests and procedures. Denials from the Advantage Plan / Insurance Company are not uncommon and may prevent or delay your necessary care. Your Doctor is often not free to decide what tests or procedures are needed for your care without the Insurance Company’s approval.t |
| Referrals are not needed to see specialists or any providers. | HMO Advantage Plans will typically require a referral from your Primary Care Physician before you can visit a specialist |
| Prescription Drug Plans Part D
Separate. This is preferred as it allows you to select from the many available plans that best cover your prescription needs. Also allows you to switch plans during the annual open enrollment period if your needs change or a better plan is available. |
Prescription Drug Plans Part D
Embedded with the Advantage Plan. This is not as desirable as the drug plan included may not adequately meet your prescription needs and/or may not be a very good plan overall. |
Recommended Reading – Advantage plans:
Medicare Advantage insurers deny care too often – The Connecticut Mirror, Nonprofit Journalism
Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care– U.S. Senate Permanent Subcommittee on Investigations October 17, 2024
It’s Time to End the Medicare Advantage Scam – The Nation
How Medicare Advantage Scams Seniors – Newsweek
Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds – New York Times
Staggering” Watchdog finds Medicare Advantage Plans Deny Necessary Care
Medicare Advantage pros and cons– USA Today
Check Out Coverage Rules Before Buying A Medicare Advantage Plan– Forbes
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need