Medicare Advantage Plans

Beginning in 2006, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) provides for an expansion of the Medicare Advantage plan options. The intent of the federal legislation is to allow private companies to provide Medicare benefits. Medicare pays the Medicare Advantage plan a set amount of money each month per enrollee. In return, the Medicare Advantage plan provides the coverage that was provided by the Medicare program and any supplemental benefits.

Medicare Advantage plans take the place of your traditional Medicare coverage. They may or may not charge a monthly fee. However, Medicare Advantage plans are annual contracts, and may increase their monthly fee over time.

Medicare Advantage plans may include deductibles and copayment/coinsurance amounts (out-of-pocket expenses) that do not apply to Wisconsin standardized Medicare supplement policies.

Medicare Advantage plans are not subject to the same benefit standards that apply to approved Wisconsin Medicare supplement policies. They are not required to cover benefits mandated by Wisconsin insurance law. Examples of benefits mandated by Wisconsin insurance law include chiropractic care and treatment of mental and nervous disorders, alcoholism and other drug abuse. OCI publishes a Fact Sheet on Mandated Benefits in Health Insurance Policies (oci.wi.gov/pub_list/pi-019.htm) that is available on OCI's Web site.

Information regarding the difference between Medicare Advantage plans and Wisconsin Medicare supplements may be obtained by contacting the Board on Aging and Long Term Care (longtermcare.state.wi.us/home/) or your county benefit specialist (dhfs.wisconsin.gov/aging/genage/benspecs.htm).