Medicare Advantage
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It’s almost open-enrollment time for seniors interested in Medicare Advantage, and if trends hold, an increasing number of Virginians will opt for coverage through private providers over traditional plans.
Open enrollment runs Oct. 15 through Dec. 7. It's a time when seniors in Medicare Advantage plans make changes to coverage, or for those in traditional Medicare coverage to switch to an Advantage plan, among other options.
Nationally, about 31 percent of seniors have Medicare through private providers, about a 5 percent increase from 2015, according to a Kaiser Family Foundation report. The plans have accounted for a small portion of Medicare coverage, but have seen their share grow about 50 percent overall over five years, according to UnitedHealthcare. The Kaiser Family Foundation notes that projections call for private providers to account for 41 percent of enrollments in 2026.
Here in Virginia, private plans account for about 16 percent of enrollments, according to the Kaiser foundation, about half the national average. They are more popular in the Richmond area, holding about 23 percent of the market. That represents a 71 percent increase in coverage in Richmond in five years, according to UnitedHealthcare.
“We’re actually in great growth here in Richmond,” says Steve King, CEO of UnitedHealthcare Medicare & Retirement in Virginia.
To help sort the differences between Medicare and Medicare Advantage and other coverage for seniors, we’ve collected advice from some experts: King; Jane Sung, a senior strategic policy advisor for the AARP Public Policy Institute; and Andrew Barnes, assistant professor in health behavior and policy at the VCU School of Medicine.
Traditional Medicare remains the most popular choice. Sung explains that it allows you to see any doctor or provider who accepts Medicare without a referral or authorization. You do pay fees, including a co-payment and deductibles, and pay for prescriptions, but patients can supplement Medicare with Medigap coverage or Part D prescription coverage to help allay costs. King notes that under traditional Medicare, the plan covers 80 percent of expenses, and the patient is responsible for 20 percent.
Medicare Advantage is Medicare coverage purchased through private providers instead of through the federal government. They provide services offered through traditional Medicare, but many also offer services such as fitness, dental, and vision and hearing screenings, and have lower co-pays and fees, according to Sung. There’s generally no need for Medigap or additional Part D prescription coverage if you have Medicare Advantage.
Barnes speculated that seniors who are now becoming eligible for Medicare coverage are more tech-savvy and more comfortable shopping online for their coverage. He also noted that many seniors are attracted to the additional health services available through the Advantage plans.
Many of the Medicare Advantage plans offer HMO- (about two-thirds of plans) or PPO- (about a third of plans) type coverage, so you’re more limited in your choice of providers than in traditional Medicare. Networks are more robust in urban centers such as Richmond, with more limited choice in less populated areas, says King.
You need to do your homework with any plan. There are trade-offs and advantages and disadvantages in each, depending on your particular needs and situation. Are your doctors and favorite facilities in the network? What are the differences in costs and coverage? What are your health needs? Consider these questions before purchasing coverage.
CAPSULES
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