Do You Need a Medicare Advantage Plan?

Do You Need a Medicare Advantage Plan?
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Editor’s Note: This article is part of MOAA’s 2021-22 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2021 issue of Military Officer magazine.


The more you know about Medicare Advantage Plans, the better your chance at being satisfied if you purchase one. Here are some tips for understanding how they work.


The common form of Medicare is Original Medicare Parts A and B, with coverage provided by the federal government. Advantage plans are Medicare Parts A and B — the difference is they are offered by commercial health care insurance firms. These plans are also called Medicare Part C.


Advantage plans are approved by Medicare and by law must provide the same coverage as Original Medicare. However, Advantage plans can offer more coverage, and they are allowed to charge a higher premium for extra coverages.


[RELATED: The Benefit Under Threat: Saving TRICARE For Life]


All Medicare plans charge you the Part B premium as determined by your income level. Advantage plans will tell you how much extra they charge above your Part B premium, if any. Some plans may cost less than your Part B premium, and they will reimburse or rebate a portion of the premium.


Changing Plans

You can join, switch, or drop a plan during the open enrollment periods. The Medicare open enrollment runs Oct. 15 through Dec. 7 each year. Your coverage begins on Jan. 1 as long as the plan receives your request by Dec. 7.


The Medicare Advantage open enrollment period is from Jan. 1 to March 31 each year. You can switch to a different Medicare Advantage plan or switch to Original Medicare during this time.


Advantage Plans and TFL

TRICARE For Life (TFL) acts as a Medicare supplement plan with either Original or Medicare Advantage plans. You need no other Medicare supplement. While Original Medicare links in-system with TFL so you never see a bill or file paperwork, Advantage plans do not.


You may have to file your own claims to TFL after the Advantage plan pays its share. However, some Advantage plans coordinate with TFL on bill payments, so you won’t have to file claims.


More Benefits and Access

The plans may offer more benefits and a chance of better access to health care providers, depending on locale. Doctors in your area may be more motivated to accept a Blue Cross Blue Shield PPO Advantage plan over Original Medicare, for example.


[RELATED: This Government Report Estimates the Next 6 Years of Medicare Part B Premiums]


The additional benefits are found in options in Advantage plans, and each plan has its own options, such as vision, dental, hearing, worldwide emergency care, in-home support, home safety devices and modifications, and emergency response devices like a Life Alert.


Provider access is key to choosing an Advantage plan. Will you be able to find providers with your plan? Ask your current doctors which plans they participate in. Know the health care networks in your area and their service records to decide if they may be a good choice for your plan.


Also, watch for whether an Advantage plan has a built-in drug plan. Everyone with TFL already has the TRICARE pharmacy plan. If you add an additional plan, you may have to file manual claims to TRICARE for additional drug reimbursements.


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About the Author

Lt. Col. Shane Ostrom, USAF (Ret), CFP®
Lt. Col. Shane Ostrom, USAF (Ret), CFP®

Ostrom is MOAA's former Program Director, Financial & Benefits Education/Counseling