Understanding Medicare Advantage Plans

Are you or a loved one enrolled in Medicare? This government health insurance program for older Americans offers many choices in terms of coverage and available plans. Given this wide range of options, the California Society of CPAs (www.calcpa.org) recommends that those enrolled in Medicare understand the options available to them.


When choosing this or any other health insurance option, you should learn as much as possible about the plan before you make a commitment. The importance of this advice was proven recently in relation to some Medicare Advantage private fee-for-service plans. A Medicare Advantage Plan is designed to make it possible to extend your coverage beyond the basic Medicare programs.

These plans, which are sometimes referred to as “Medicare Part C,” are typically similar to a PPO or HMO and can combine hospital, medical and prescription drug coverage in one plan that is available through private insurers approved by Medicare.


While Medicare Advantage plans can be an excellent choice in some circumstances, Congress and many states have investigated abusive sales tactics employed by marketers selling private fee-for-service Medicare Advantage plans. According to the Center for Medicare Advocacy, those enrolled in the plans have sometimes faced difficulties in finding doctors who would treat them.

There have also been instances when a private pay-for-service plan offered no more than traditional Medicare but did charge a higher fee. These plans are also exempt from many of the regulations that apply to other types of Medicare Advantage plans.


One of your questions about any plan should be which doctors will accept this insurance, since some doctors won’t accept patients from private Medicare plans. You’ll want to know, too, whether you can see doctors or use hospitals outside the plan’s network.

Ask also about each plan’s premiums, coinsurance and deductible to make sure they are affordable and compare well with your other options, including the original Medicare plan. Find out if the plan provides added benefits beyond what you would get in the basic Medicare plan, such as prescription drug coverage. When you have a Medicare Advantage plan, you usually don’t need Medigap insurance, so confirm that this is the case when you sign up.


There are many sources of information on Medicare. The main government Web site is www.medicare.gov, or you can call 800-633-4227800-633-4227 (800-MEDICARE). There are also helpful resources on the Social Security Administration Web site at www.ssa.gov. The government’s booklet “Medicare & You” is of particular interest. For questions on another front, “Medicare Prescription Drug Coverage -- Your Questions Answered,” published by the American Association of Retired People, is available on that group’s Web site at www.aarp.org.

The 360 Degrees of Financial Literacy program, a special initiative of the CPA profession, also provides basic information at www.360financialliteracy.org under the “Retirement & Estate Planning” section. And don’t forget that your local CPA can help you understand your choices and make informed decisions about any of the financial issues you and your family are facing.

To listen to podcasts with more financial tips, go to http://www.calcpa.org/Content/community/financialempowerment.aspx.