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What Do You Need To Know
Complete Guide to Medicare Advantage (Part C) Plans
Before the Modernization Act in 2003, it wasn’t possible for a Medicare beneficiary or senior to enroll in Medicare Advantage. The only option was original Medicare benefits for people who didn’t have retiree coverage from an employer.
However, Medicare Advantage is now a popular alternative to traditional Medicare. A Medicare Advantage beneficiary can enjoy a similar level of coverage to the kind of group health insurance that many professionals access during their working years. With Medicare Advantage HMO plans, you’ll have what some people call Medicare Part C.
Although the government doesn’t sell Medicare Advantage plans, they’re still technically a part of the Medicare offering. While the government establishes rules and guidelines, the average private insurance company still administers its plans.
Advantage policies come as Humana Medicare Advantage, United Healthcare Plans, Aetna Medicare Advantage, etc.
They may have lower premiums than the Original Medicare option. Medicare Advantage plans also offer services and some prescription drug coverage not provided by Medicare elsewhere.
Who is Eligible for Medicare Advantage?
Medicare Advantage plan options appeal to a lot of seniors. The right Medicare Advantage plans will give you a convenient way to access extra coverage and peace of mind. Most plans even come with Part D prescription drug coverage included. This inclusion means that you don’t have to keep a separate cart for a prescription drug.
If you don’t visit the doctor very often, the cheaper premiums available with Medicare Advantage enrollment might be attractive. In addition, you can get a Medicare Advantage plan on its own, rather than using the federally administered program.
To enroll in Medicare Advantage plan options, you must:
- Have original Medicare (to begin with) Part A and B
- Live in the service area for the Medicare Advantage plans you’re considering
- Not have an end-stage renal disease (there are some exceptions here)
Medicare Advantage coverage needs to provide the same level of coverage as original Medicare, except for hospice care, which is still protected by part A. Some plans can also come with extra benefits like routine dental, health, or vision programs.
If you decide to switch to traditional Medicare after some time on Medicare Advantage, you can do so during the Medicare Advantage disenrollment period.
What Can A Medicare Advantage Plan Cover?
A Medicare Advantage plan can cover a range of things. For example, Medicare Part C is provided by either a private insurance company or an HMO contracted with Medicare. Look online to find out what kind of Medicare health insurance companies are available in your area.
Medicare Part C, or Advantage Medicare, usually covers the same benefits as Part A coverage. This coverage includes inpatient care in a hospital and skilled nursing care. You can also get home health care costs covered by your insurer.
For outpatient care, your Advantage Medicare coverage will often cover the same benefits as Medicare Part B, such as:
- Doctor and specialist visits
- X-rays and laboratory tests
- Ambulance services in an emergency
- Inpatient and outpatient mental health
- Durable medical equipment (wheelchairs and walkers)
- Physical and occupational therapy
- Speech and language therapy
- Preventative tests and vaccines
When it comes to extra benefits in your Medicare health plan, there’s a lot of variation. Therefore, it’s essential to look at what you will receive as a beneficiary when comparing health insurance providers. For example, unlike with original Medicare, you can usually expect routine vision and dental care, hearing assistants, and even fitness classes when a primary care doctor recommends them.
If your Medicare Advantage enrollment doesn’t cover something you need, you can file an appeal to pay less than you were requested to pay. You can also switch between different Medicare plans during the open enrollment period of October 15th to December 7th.
What Are the Common Types of Medicare Advantage Plans?
There are many different kinds of Medicare Advantage plan available today. Health Maintenance Organization plans (HMOs) and Preferred Provider Organizations (PPOs) are the most common options. HMOs have closed networks of providers, and you need to make sure that you get all of your care within that network.
You select a primary care doctor with an HMO who oversees your medical care. Your plan might require you to get a specialist care referral for certain procedures and tests. Medicare Advantage HMO plans usually come with prescription drug coverage (Part D).
Alternatively, Preferred Provider networks or PPO plans come with provider networks, but you can still use any company that accepts Medicare. You will pay much less out of pocket if you remain within your network. You don’t need specialist referrals with PPO, and you don’t need to have a primary care doctor. Most of the PPO plans available today come with Part D coverage, too.
All of the Advantage plans that you can choose from today must offer the same benefits that you would receive with original Medicare. However, many of these plans go beyond this and offer other forms of coverage like routine vision and dental programs. Make sure you compare your options to get the best plan.
What are the Costs of a Medicare Advantage Plan?
Medicare beneficiaries can expect to pay different costs for their Advantage plan, based on the kind of enrollment they choose. You’ll need to evaluate your Medicare health insurance and hospital care plan carefully to find out:
- Whether there’s a monthly premium
- Whether you need to buy Medicare Part D insurance too
- Whether you’re required to pay for a Medicare supplement Plan F
- Whether there’s a yearly deductible
- How much you pay for every service or visit in a Medicare plan
- The type of health services you can access beyond traditional Part A and Part B
- Whether you need to use a PPO, PFFS, or MSA plan
- Whether you need extra benefits, like the ability to use different providers
- Whether you have Medicaid assistance from your state
You may have heard of “zero premium” plans available from Advantage Medicare health plan companies. These packages don’t add any additional premiums above whatever you pay for your Part B premium. For 2020, the Average cost of a Medicare Advantage plan is around $35 per month.
Some Advantage plans come with deductibles, while others do not. Deductibles apply when you are using inpatient services or Part D prescription drug coverage. As a Medicare Advantage enrollee, you’ll usually pay a copayment when you have healthcare. This could mean that you spend around $20 when you visit your primary care doctor. Alternatively, you might spend around $75 for an emergency room visit. The cost of prescription drugs comes from a tiered system.
Is Medicare Advantage Better Than Traditional Medicare?
If you access Medicare Advantage instead of Medigap or a different form of Medicare coverage, then it’s worth noting one key difference. Medicare Advantage plans have an out-of-pocket limit. Once you meet your “MOOP” payment limit, you won’t pay anything for your covered healthcare for the remainder of the calendar year.
Although the average MOOP for your Medicare health plan will be applied by your insurer each year, you can set the amount to be lower. The kind of costs that you pay will depend heavily on the private insurer that you choose. This sets Medicare Advantage apart from traditional Medicare.
Deciding whether Medicare Advantage is right for you will mean considering your medical situation and needs. Some people will be able to use a combination of Original Medicare with Part B and Part D coverage to manage their costs. Other people like the security that Medicare Advantage can offer.
One point to note about Medicare Advantage is that it can be restrictive in some cases. For example, if you travel too often, the networks available through Medicare Advantage could mean that it’s difficult to get the healthcare you need when you’re on the road.
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