Below is an interview with Joseph Barrows, LUTCF, Sales Director, at Medicare Resource Center of Grand Junction. The purpose of this Q&A is to provide information about Medicare Advantage. 

*Please note that Mr. Barrows is an insurance agent who works with clients to assist in finding the right plan for them. Insurance agents are paid by the insurance companies and not by their clients. 

Q: Can you briefly provide an overview of Medicare Advantage?

A: Traditional Medicare consists of Part A and Part B. Part A typically covers larger expenses such as hospital stays, new hip, rehab, etc. Part B covers your outpatient services. Medicare Part A or B covers 80% of a bill and the patient pays 20%. 

The Medicare Advantage plans cover all services of Medicare Part A and B. Instead of paying 20% of Part B costs, the patient mostly has fixed copays (some exclusions apply). Care Management is built into the plans for members who have additional needs and there are additional services provided like routine physicals, dental, vision and hearing exams, hearing aids discounts, health club memberships. Over The Counter purchase cards and meals after an in-hospital stay are part of most benefit packages on Medicare Advantage.

Q: Who can join the Medicare Advantage plan?

A: Someone must be enrolled in Medicare Part A and Part B. Medicare is for individuals 65 and over. If they currently have Medicare, they can switch to a Medicare Advantage plan during open enrollment from October 15-December 7. There are exceptions to the timeframe so it is best to talk with an insurance agent who can answer questions about the client’s specific situation. 

Q: What are the main benefits of the Medicare Advantage plans vs. Medicare?

A: Some of the advantages of Medicare Advantage include:

  • Medicare Advantage includes both Plan A and Plan B plus additional benefits. 
  • Medicare Advantage does have an out of pocket maximum for beneficiaries. It varies based on the plan, but the maximum amount is usually $6700 and many plans may be even lower than that. Original Medicare doesn’t have a spending limit so having a maximum amount helps to reduce the financial risk and it gets rid of unlimited exposure of costs. The carrier keeps track of the copay spending and if it hits the limit, the carrier will pay 100% for the rest of the calendar year for medical services.
  • Fixed co-pays for most of the procedures.
  • Medicare Advantage plans can include dental and vision as well. 
  • Part D medications can be added to a Medicare Advantage plan with a lower premium.

Q: What should someone be aware of when considering the Medicare Advantage plan?

A; While there are copays on Medicare Advantage, there are exceptions including durable medical equipment (oxygen, wheel chair, prosthetic devices, etc.) and Part B chemotherapy drugs. These remain under the 20% model. In addition, it is important to make sure the plan includes providers they wish to see or patients should at least know what it will cost to continue going to them before selecting a plan. 

Q: What are the costs of the plans? 

A: Members can get a plan with a zero monthly premium. If there is a cost, in the Grand Valley, most Medicare Advantage plans are not more than $40 per month. Medicare Supplements could be added but with the Medicare Advantage plans, beneficiaries can get dental, vision, physical, and hearing exams included. 

Q: Why is it important for our community to encourage people to consider the Medicare Advantage plans? 

A: If people receive vision and dental benefits with their Medicare Advantage plan, then the insurance plan covers the cost. Local organizations currently stepping in to provide these services are then able to free up dollars and focus efforts elsewhere. 

Q: How would someone learn more about Medicare Advantage?

A: They could call the Medicare Resource Center, please call 970-243-3100 or stop by 327 N. 7th Street, Grand Junction, CO 81501. They can also visit to compare plans.