Medicare Advantage Plans in Kansas City Explained

What Medicare Advantage is

A Medicare Advantage plan is offered by a private insurance company approved by Medicare. It takes the place of Original Medicare for your hospital (Part A) and medical (Part B) care. You still have Medicare, and you still pay your Part B premium, but the plan handles your bills and your card.

These plans must cover everything Original Medicare covers. Many also add extras, and most include drug coverage.

Common plan types

• HMO (Health Maintenance Organization): You use doctors in the plan's network, except in an emergency. You often need a referral from your main doctor to see a specialist.
• PPO (Preferred Provider Organization): You pay less with network doctors, but you can see doctors outside the network for a higher cost. Referrals are usually not needed.
• Other types: There are also Special Needs Plans (below) and a few less common kinds. We will explain any plan we show you in plain words.

What it covers

Hospital stays, doctor visits, tests, and other care Original Medicare covers. Most plans also include Part D drug coverage, so you do not need a separate drug plan. Many add extras like dental, vision and hearing benefits.

What you pay

Some plans have a monthly premium and some do not. You pay copays or coinsurance when you get care. Each Medicare Advantage plan has a yearly out-of-pocket limit. Once your costs for covered care reach that limit, the plan pays for covered services for the rest of the year. Each plan sets its own limit up to a cap Medicare sets. Learn more on our Medicare costs page.

Who it fits best

People whose doctors and hospital are in the plan's network, who like having one card for most of their care, and who are comfortable with a network and plan approvals.

Networks: your doctors and hospital come first

The plan name does not matter much if your doctor is not in it. Before you choose, we check whether your doctors, specialists and hospital are in the network. In Kansas City, many people see doctors in both Missouri and Kansas, so we check each one.

Networks change every year. A doctor who is in a plan this year may not be next year. We check for you each fall. Read how we check your doctors and hospitals.

Prior authorization, in plain words

Prior authorization means the plan has to say yes before it pays for certain care. That might be a scan, a surgery, a stay in a rehab center, or a costly medicine. Your doctor's office usually sends the request. If the plan says no, you can appeal.

We know this is the part people worry about most. Nobody wants to be told no when they are already sick. That is why we look at it with you. We talk about the care you get now and what you expect, and we help you weigh that against how each plan works before you enroll.

Special Needs Plans

Special Needs Plans, or SNPs, are Medicare Advantage plans built for certain groups. All of them include drug coverage.

• D-SNP (Dual Eligible): For people who have both Medicare and Medicaid. These plans can help the two programs work together.
• C-SNP (Chronic Condition): For people living with certain long-term health conditions, like diabetes or heart failure. Each plan lists which conditions it serves.

Each type has its own rules for who can join. We can check whether one is offered in your area and whether you qualify.

Part B giveback plans

Some Medicare Advantage plans, in some areas, reduce the amount you pay for your Part B premium. It is only one part of the plan. A giveback plan still needs to fit your doctors and your medicines. We can help you see whether a Part B giveback plan is offered in your area.

Extra benefits

Many plans include dental, vision and hearing benefits, and some include an allowance for over-the-counter items like vitamins or bandages. These extras vary a lot from plan to plan. Some dental benefits cover only cleanings, while others help with fillings or more. Read the details before you count on them, or ask us to read them with you. See dental, vision and hearing for other options.