If I Have Medicare Advantage, Why Do I Need Medicare Part B?

Ask Rusty – I Have Medicare Advantage - Why Is a Medicare Premium Deducted from my Social Security?

Dear Rusty: My wife and I have a Medicare Advantage Plan, and we do not use Medicare for our claims. However, we still have the Medicare premium deducted from our Social Security checks. Is this correct? Signed: Wondering

Dear Wondering: If, after age 65, you choose to take Medicare outpatient coverage of any kind you must pay that Part B premium, even if you decide to acquire a Medicare Advantage plan instead of using "original Medicare" to administer your healthcare claims.

Medicare Advantage plans (often referred to as Medicare "Part C") are healthcare plans offered by private insurers who will administer your healthcare claims instead of the Federal Government. But you cannot get a Medicare Advantage plan without first being enrolled in Medicare Part A (inpatient hospitalization coverage) and Part B (coverage for outpatient services) and paying any associated Part B (and perhaps Part A) premium.

As you know, you pay a low premium (or perhaps no premium) for your Medicare Advantage plan. That's because the Part B premium you are now paying from your Social Security is actually going to your Medicare Advantage plan provider, enabling them to offer you equivalent coverage at little or no additional cost. Some Medicare Advantage plans even provide added coverage which Medicare Part B doesn't, such as dental and vision and, sometimes, prescription drug coverage. If that all sounds enticing, remember that Medicare Advantage plans usually also include restrictions on which medical service providers you can use, unlike "original Medicare" which permits you to use any medical service provider who accepts Medicare (nearly all).

So, when you see or hear a Medicare Advantage provider advertising "no cost" or "very low cost" coverage, recognize that they can offer that only because the government pays them a fixed amount for your care from the Medicare Part B premium taken from your Social Security. The Part B premium you are paying from your Social Security benefit is why your Medicare Advantage plan premium is as low as it is.

Many people like the cost efficiency and extra coverage provided by Medicare Advantage plans and are comfortable with the restriction to use "in-network" providers. Many others choose "original Medicare'' because of the inherent flexibility to use just about any healthcare service provider they wish. You should always carefully evaluate which type of healthcare coverage is right for you personally.

This article is intended for information purposes only and does not represent legal or financial guidance. It presents the opinions and interpretations of the AMAC Foundation's staff, trained and accredited by the National Social Security Association (NSSA). NSSA and the AMAC Foundation and its staff are not affiliated with or endorsed by the Social Security Administration or any other governmental entity. To submit a question, visit our website (amacfoundation.org/programs/social-security-advisory) or email us at ssadvisor@amacfoundation.org.

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