The number of Medicare beneficiaries enrolling in Medicare Advantage insurance has grown exponentially, more than doubling since 2010. This year, about 54% of beneficiaries are enrolled.

The KFF (formerly Kaiser Family Foundation) cites 10 reasons for this growth. Among them are that some plans have no monthly premium, many offer additional benefits, all set a cap on annual medical expenses, companies market their plans aggressively, and these plans offer insurance brokers a more lucrative commission structure.

It is projected that by the end of the decade, 60 percent of Medicare beneficiaries will be enrolled in such plans.

So what should you know about this type of insurance? The most important questions are answered below. (Salem Reporter published an analysis of Medicare supplemental insurance, also called Medigap insurance, in July.)

Who is Medicare Advantage insurance best for?

Beneficiaries give many reasons for choosing this type of insurance. Among them:

• Many of the plans — 12 of which are available in Marion and Polk counties — do not charge a monthly premium. This is attractive to both low-income individuals and those on a tight budget. Insurance companies can offer “free” insurance because Medicare subsidizes the monthly premium by more than $1,000.

•These plans often have lower out-of-pocket costs for medical services and treatments than Medicare alone.

•Some beneficiaries are lured by “extras” such as gym memberships, an annual dental care allowance, ambulance services, medical alerts, quarterly allowances for approved over-the-counter pharmacy items, and home delivery of meals after surgery.

• These plans provide protection against out-of-control medical expenses because, unlike basic Medicare insurance, they set a cap on annual medical expenses.

How much are the premiums for Medicare Advantage insurance?

Eight companies offer Medicare Advantage insurance plans to beneficiaries in Oregon, with more than 25 plans covering both medical and prescription drugs available to Salem-area residents.

Premiums range from nothing (12 plans) to $155 per month.

What kind of copayments are associated with Medicare Advantage insurance?

Let’s look at select copayments for plans that don’t charge a premium. Here’s an example:

•Family doctor: no additional payment.

•Specialist: $35-50.

•Laboratory testing: $0 to $50 (most plans have no lab copayment).

•Hospital emergency room: $90-$135.

•Emergency Care: $25-$65.

•Inpatient hospital stay: $320–450 per day, with the number of days varying from four to six.

Paying a premium should reduce copayments. A beneficiary who anticipates relatively high medical costs would most likely benefit from comparing the plans’ maximum annual out-of-pocket costs, which range from $3,450 to $8,850 for the no-premium plans (four plans cost $5,000 or less).

Does Medicare Advantage insurance cover prescription drugs?

Most of these plans cover prescription drugs. Premiums and benefits can be viewed on the Medicare.gov website. Unfortunately, there are plans that cover drugs with those that do not.

When you review or enroll in plans on this site, be sure to select the type you want (most beneficiaries want both health and drug coverage). You can use the site’s filter to limit your review to plans that include drug coverage.

Is it difficult to change Medicare Advantage insurance?

No. Most beneficiaries can change their plan during the fall open enrollment period, officially known as the annual election period, which runs from October 15 to December 7. New coverage begins on January 1.

If you receive financial assistance to pay your Medicare or prescription drug costs, you can switch plans once per calendar quarter. To see if you qualify for such assistance, call Oregon’s Adult and Disability Resource Connection at 503-304-3420.

Does Medicare Advantage insurance cover more than Medicare?

Yes. Although the “extras” the plans cover vary, they are competitive in their extra offerings.

Medicare seems a bit complicated. What’s the best way to avoid mistakes?

Beneficiaries make mistakes from time to time. These are the main causes of errors.

•For a Medicare Advantage plan to work, your doctor must be in that insurance company’s network (that is, the doctor must be able to bill the insurance company). You can find out this either by calling the doctor’s office or by calling the insurance company.

• You want to be sure that the insurance plan you choose adequately covers your prescription drugs. Enrolling in an insurance plan that doesn’t cover even one of your drugs could be expensive. The Medicare.gov website asks you to enter your drug list to find out which plans cover your drugs and at what cost.

• It’s both tempting and important to focus on the copayments you’ll be charged for medical services, but consider the maximum annual out-of-pocket expenses you could incur. If you have high annual medical costs, this is critical.

•If you see something that is confusing or sounds too good to be true, call the insurance company to clarify (and perhaps ask for confirmation on the website as well). Although the Medicare website is excellent, sometimes it shows benefits such as full coverage for glasses or contact lenses (which is unlikely).

How is Medicare Advantage insurance different from Medicare Supplemental Insurance (Medigap)?

These two types of Medicare insurance differ significantly: the amount of the monthly premiums, whether the patient has to expect co-payments, whether a referral to a specialist is required, how to switch insurance annually – and that’s just the beginning.

A good description of the differences between Medicare Advantage and Medigap insurance can be found on pages 48-49 of the Oregon Guide to Medicare Insurance Plans. A list of all companies that sell Medicare Advantage insurance plans in Oregon, including their phone numbers and websites, can be found on page 56. (Companies that sell Medigap policies can be found on pages 40-41.)

Does PERS offer Medicare Advantage insurance?

The Public Employees Retirement System offers five such plans, all of which include prescription drug coverage (one of these plans is not available in Marion and Polk counties). These plans are available when public employees in Oregon (state, city, county, school district, etc.) first have full Medicare coverage. A PERS brochure shows the benefits and monthly premiums for each of these insurance plans. PERS representatives (800-768-7377) can provide comprehensive information and answer questions.

Jim Sellers of Salem is a certified Medicare counselor in the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, email (email protected). To schedule a free SHIBA phone appointment, Zoom appointment or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.

STORY TIP OR IDEA? Email the Salem Reporter news team: (email protected).

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