Closer Look: Medicare Advantage Plans

June 20 , 2007 - Posted at 2:58 p.m. CDT

JONESBORO-In a follow up to a story we aired last Friday about supplemental Medicare insurance, we told you about one woman's experience with her supplemental Medicare policy.

Based on information K8 obtained after the broadcast, we now believe that the woman's problems were unique to her, and we do not have any reason to believe that Windsor Medicare Extra, the woman's insurer, violated any responsibility that it had to her.

Medicare coverage can be confusing, and it's important for consumers to understand their policies to be sure that their old insurance is not cancelled until the new one takes effect.

Now K8's Will Carter takes a closer look at the Medicare Advantage form of insurance.

-For seniors - choosing the right Medicare plan can be somewhat confusing.

Currently Medicare has four plans to chose from:

Part A - Pays for hospital visits

Part B - Pays 80% of standard medical costs

Part C - Includes supplemental plans

Part D - The new prescription drug plan.

Of these, Part C has become one of the more popular, combining traditional Medicare coverage with more options to beneficiaries.

"Some of them offer some additional services like eye glasses and eye exams, or things that might not be available under original Medicare," said Rod Clark of Medicare.

But it's not as simple as just signing up for the extra services.

"The confusion that takes place is that Medicare Part C is called Medicare Advantage, and there are two types of Medicare Advantage plans. What seniors have to figure out is what type of Medicare Advantage plan fits their needs best," said Gary Adkins of Windsor Medicare Extra.

The first plan is a private fee for service plan which pays healthcare claims, but often has higher co-pays and does not have contracts with healthcare providers.

The other plan is a network based plan.

"A network based plan simply means that the member receives a large list of local doctors and hospitals that have signed a contract with the plan saying that we guarantee services and acceptance of this plan," said Adkins.

Windsor Medicare Extra is a network based plan. They say another big difference in these plans are the requirements to each.

"Fee for service plans do not have to have the minimum Medicare A and B requirements. A network based plan, like Windsor, we must have at minimum everything people have gotten from their traditional Medicare A and B plus the drug program," said Adkins.

Both Windsor and Medicare say the best place for information is a publication called "Medicare and You."

It is distributed yearly and is also available online.

This resource outlines all of the Medicare Advantage Programs, however, Medicare representatives say it's really just a matter of preference.

"It gets down to a cost versus choice thing. A person may save some money on one of these Medicare Advantage plans, but most of those do have a network of providers, so a person may not be able to go to the physician or hospital they would choose to go to," said Clark.

Meanwhile, network providers say it's a guarantee that makes their plans stand out.

"They need to determine, do you want a plan that is contracted by your local hospitals and doctors or one without contracts? Do you want a guarantee versus no guarantee? It's that simple," said Adkins.

And both Medicare and Windsor agree, the more questions you ask, the better you'll be informed.

Helpful Links and Numbers:

Medicare Website :

Medicare Phone:  1-800- MEDICARE

Windsor Extra Website:

Windsor Extra Phone:  1-800-811-8482

Story ideas or comments?  Email Will at