The Ideal Client for Medicare Advantage Plans

Since 2008, Medicare Advantage Part C has been a great alternative for seniors looking to lower their premiums and out-of-pocket costs.

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In 2022, more than 28 million beneficiaries — or more than half of the eligible population — are enrolled in a Medicare Advantage plan, according to KFF. With more than 39 Medicare Advantage plans available for the beneficiary, your clients have more choice than ever. It’s your job to decipher which clients will benefit from these plans, but you don’t have to do it alone. Ritter is here to help!

Who Is Eligible for Medicare Advantage?

According to Medicare.gov, someone is generally eligible to join a Medicare Advantage (MA) plan if they:

• Have Medicare Parts A and B* (called Original Medicare)
• Live in the service area of a plan
• Are a U.S. citizen or are lawfully present in the U.S.

*In order for someone to be eligible for Medicare Parts A and B, they must be 65 or older or have a qualifying disability or End-Stage Renal Disease.

Who Should Enroll in Part C?

Your client might tick all of the boxes when it comes to eligibility, but that doesn’t mean they should enroll in an MA plan.

These type of beneficiaries are ideal clients:

People with a Limited Budget

Clients with a small or fixed budget want a reliable plan that isn’t going to break the bank. According to Boston Consulting Group (BCG), about 30 percent of the Medicare market are value seekers, who want affordable payments and extra benefits. In order to help with financial stress, some MA plans have dental benefits and allowances for glasses, hearing aids, and over-the-counter medications, which aren’t covered by traditional Medicare.

The lower premiums that come with MA plans are enticing to clients trying to fit health care in their budget.

In 2020, about nine percent of Americans older than 65 lived in poverty, with a household income of less than $12,413 for a single person, according to the U.S. Census Bureau. Even those not considered in poverty live on fixed incomes with little wiggle room. For example, “Among Social Security beneficiaries age 65+, Social Security represents 50% or more of their income for 37% of men and 42% of women.” The lower premiums that come with MA plans are enticing to clients trying to fit health care into their budget. Offering D-SNPs to clients with lower incomes will help them provide for them and their family without breaking the bank.

People with Medicare Advantage Options in Their Area

MA plans are offered by private insurance companies, and members must reside in the service area of that plan. While this may seem inconvenient, plans actually often provide richer benefits to compensate for the specific provider networks. If your client has a small group of trusted doctors and those doctors are in an MA plan’s network, this could be the right fit. It’s important to note, however, that some plans charge extra for doctors outside of their network.

If your client has a small group of trusted doctors and those doctors are in an MA plan’s network, this could be the right fit.

People Who Expect Minimal OOP Costs

If your client is expecting minimal out-of-pocket (OOP) costs, it would be beneficial to enroll them in an MA plan with a Medical Savings Account (MSA). These are great for healthy and active seniors who only go to the doctor for their recommended appointments and checkups. Medicare MSA plans also give members the flexibility of rolling their remaining balance to the next year.

Medicare MSA plans also give members the flexibility of rolling their remaining balance to the next year.

People with Chronic Illness or Declining Health

For those dealing with serious conditions, MA plans could provide a higher level of assistance. About 85 percent of older adults have at least one chronic illness and 60 percent have at least two, according to the Centers for Disease Control and Prevention (CDC). Chronic Condition Special Needs Plans (C-SNPs) and other MA plans are also enticing if someone has a pre-existing condition. There’s limited discrimination, and if a plan no longer fits, they have the option to switch during the Annual Enrollment Period, a Special Enrollment Period, or via their Medicare Advantage trial right.

There’s limited discrimination, and if a plan no longer fits, they have the option to switch at least once annually.

People Who Don’t Travel Far From Home

It’s important to know your clients’ habits in order to sell them the right plan. MA plans operate within service areas that are sometimes as small as a zip code, so they’re ideal for someone who likes to stay home. Since members won’t have to worry about filling prescriptions or seeing a doctor out of state, this plan could be the right fit!

MA plans are ideal for someone who likes to stay home.

People Looking for Convenience

Your clients shouldn’t choose a plan solely based on convenience, but it is a perk. A positive thing about MA plans is that they combine Original Medicare and drug coverage. This means one single card is used for everything and the payments are wrapped into one.

A positive thing about MA plans is that they combine Original Medicare and drug coverage.

When seniors turn 65, they are bombarded with the different plans and providers they can choose from. Your job is to help make sense of all this information and help choose the best plan for their needs. MA plans are great options for many clients, and hopefully it is easier now to find the best fit!