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Ask the Expert: How do Medicare Advantage Plans work?

Answers by Michele Mathias, owner of Mathias Insurance Services, Alexandria

If I have a Medicare Advantage Plan do I always need to see a physician that is in my plans network?

Medicare Advantage Plans have higher co payments and maximum out of pocket for physicians out of your plans network. An exception to this is the United Health Care Medicare Advantage Plan. You may see any physician or go to any medical group around the nation that accepts Medicare. The co payments and maximum out of pocket are the same for out of network as in network. This is very important for residents in rural areas that will need to travel for certain medical care; however dental, hearing and vision need to be in network.

Michele Mathias of Mathias Insurance. Contributed photo

What is most popular with seniors? Medicare Advantage Plans or Medigap plans?

Medicare advantage plans have experienced a high enrollment growth. From 2013 to 2020 Medicare advantage plans saw a 60 percent growth. It is important to know the difference between the two. Also, note the plan that your friend is on in Fergus Falls may not be available in Glenwood, as plans differ by zip codes.

I am a veteran. Can I get on a Medicare advantage plan?

The United Health Care Patriot plan was designed to give extra benefits to our well deserving veterans 65 or older. These plans do not interfere with their current VA benefits and add extra help for hearing, dental, vision and over the counter pharmaceuticals. These plans are available in most Minnesota counties, but not all.

Can I get on Medicare if I am not collecting Social Security yet?

Yes. You will want to sign up for Medicare Part A (hospitalizations) through the social security administration website or visit your local office. Part A is free except under special circumstances. If you are already collecting social security then you will automatically be signed up for part A. You may sign up for Part B three months before your 65th birthday or 3 months before you lose your employee medical benefits. When you get your Part B Medicare card, now it’s time to search for a medigap or MAPD plan.

Do I pay a premium for Part B?

Unfortunately, yes. The amount you pay is based on your income adjusted two years prior. Singles making under $88,000 and couples filing jointly under $176,000 pay $148.50 a month. The next level is singles making $88,000 to $111,000, which will pay $207 a month, and so on. Medicare will collect this premium automatically from your Social Security deposit. If you do not receive Social Security yet you will need to pay Medicare directly by automatic withdrawals or they will bill you quarterly.

Find out more

Michele Mathias specializes in all aspects of retirement planning including Medicare solutions, protecting your retirement investments and legacy planning. Michele lives in Alexandria and serves all of Minnesota. To set up an in-person meeting or Zoom call, contact Michele at 320-491-8857.

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