As a senior citizen or other eligible individuals, choosing the best Medicare Advantage plan is an important decision to make and can be frustrating. Regular Medicare might seem easy and safe, but there are some valuable options you might miss if you don’t check out the benefits of Medicare Advantage.
What is Medicare?
Medicare began in 1966 in the United States of America. It is a national health program that provides health insurance for seniors 65 years of age and above. It also provides health insurance for young people with disabilities, people with ALS (amyotrophic lateral sclerosis), and those with end-stage renal disease.
What is Medicare Advantage?
Medicare Advantage is also referred to as Medicare Part C. It enables people with Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to get their Medicare benefits differently.
Medicare Advantage plans are offered by private insurance companies which are contracted with Medicare and provide similar coverage levels as that of Medicare Part A and Medicare Part B.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans to choose from.
Preferred Provider Organization (PPO)
This plan charges different rates for your network and in-network services. This plan has network doctors, hospitals, and other healthcare providers. You pay less when you use healthcare providers, hospitals, and doctors within the network. You pay more when you use doctors, hospitals, or health care providers outside the network.
Special Needs Plan (SNP)
This plan is for certain chronic illnesses and low-income situations. Medicare SNPs offer their provider choices, benefits, and drug formularies to meet the needs of the persons covered within this plan.
The beneficiary in this plan gets services from doctors, healthcare providers, and hospitals within the SNP network.
Health Maintenance Organization (HMO)
This plan exempts out-of-area urgent care, emergency care, and out-of-area dialysis.
HMO plans cover prescription drugs. This plan also notifies you if your healthcare provider or doctor leaves the plan, allowing you to choose a new one. You will be required to pay the full cost if you choose a healthcare provider outside of the plan.
Private Fee-For-Service (PFFS)
This plan offers the flexibility of payment plans to providers. This plan is not similar to Medigap or regular Medicare plans.
This plan determines the amount of money to pay other healthcare providers, doctors, and hospitals. It also determines the cost you pay after receiving care.
A PFFS plan enables you to see other doctors or visit other healthcare facilities. If you join a PFFS Plan that has a network, you can visit doctors who want to see members of the plan. You can choose an out-of-network doctor, hospital, or healthcare provider who agrees to the terms of the plan.
How to Get the Best Medicare Advantage Plan for Your Needs
Deciding on the best Medicare Advantage plan can be overwhelming. You should consider many things before making a decision. Before selecting the best Medicare Advantage plan, ask yourself several questions.
Ask yourself how much you’ve spent on healthcare in previous years. This will help you determine your budget and how much you can pay on out-of-pocket costs and premiums. Some plans offer deductibles and $0 premiums, but others charge a few dollars. This is a common medical benefit for employees.
Also, be sure to ask yourself what prescription drugs you take or need. Seek a Medicare Advantage plan that covers prescription drugs you take or consider purchasing Medicare Part D. You can check each plan’s drug list to ensure that your medications are covered.
Next, you will want to ask yourself what kind of coverage you need. Some Medicare Advantage plans have extra coverage options like vision, dental, and hearing. Consult carriers to see the plans they offer.
Check the medical conditions you have and any long-term medical needs you may require. Chronic health conditions are common among many Americans. You want to choose a medical plan that best suits your long-term healthcare needs.
Ensure that you know what kind of Medicare your current healthcare providers participate in or accept.
Make sure you know the CMS (Centers for Medicare and Medicaid Services) rating for the plans you are considering. The quality of healthcare provided by Plan D and Medicare Advantage is measured by a five-star rating set forth by the CMS.
This rating measures certain things like the availability of care, the management of chronic conditions, drug pricing, customer service, complaints filed, member experience, and much more. The star ratings are released every year by the CMS, so be sure to check them out on an annual basis.
How is Regular Medicare Similar to Medicare Advantage?
Medicare Advantage plans offer the same benefits as Medicare part A and Medicare part B. So, if a Regular Medicare plan covers healthcare at a certain level, the Medicare Advantage plan will do so too. If you have been enjoying certain Medicare benefits from part A and/or part B, you won’t lose out on those benefits if you choose a Medicare Advantage plan.
The Benefits of Medicare Advantage
Better Coverage Options
Regular Medicare has only two types of coverage: medical insurance and hospital insurance. For additional coverage, you will need to buy Medicare Part D, which is for prescription drugs, and for supplemental coverage, you would need to purchase Medigap. The Medicare Advantage option can give you all of your coverage options in one plan.
Customizable Plan Structures
You can enjoy different types of plans for your healthcare requirements with Medicare Advantage. For instance, if you have a chronic health condition, you can opt for an SNP (Special Needs Plan) Advantage plan to assist you with your medical costs.
For more provider freedom, you can choose a PFFS or PPO plan. Many Medicare Advantage plans include extra services like hearing, dental, or vision.
Most Medicare Advantage plans offer low deductibles or no premiums. Also, most plans have limits on the out-of-pocket costs you pay annually. You also save money on medical equipment and laboratory services.
Coordinated Healthcare Among Your Healthcare Providers
Coordinated Medicare is common in most Medicare Advantage plans. This means that healthcare providers can communicate with other medical specialties and healthcare services to coordinate and individualize your care. This is beneficial since it gives you a healthcare team to help with things such as medication interactions.
Regular Medicare does not cover you when you are out of the country and need medical care, even during an emergency. Medicare Advantage, on the other hand, may cover part of your emergency healthcare when you are out of the country.
Other Things to Consider with Medicare Advantage Plans
Most people are satisfied with Medicare Advantage plans’ health coverage. However, these plans do have a couple of disadvantages associated with them.
You may find you have limited freedom of choice in service providers. For example, if you select one plan type of Medicare Advantage plan, like an HMO plan, you will only see the providers covered by that plan.
This means that you may incur higher fees when seeking an out-of-network healthcare provider. Some other plans give you provider freedom, but those plans typically have higher premiums and fees like deductibles and copays.
There may be extra coverage costs. Medicare plans charge deductibles, premiums, and coinsurance for Parts A and B plus any Medigap or Part D costs. You may notice additional fees for Medicare Advantage plans like specialist visits, copays, and drug deductibles.
Original Medicare coverage applies throughout the United States. Some Medicare Advantage plans offer state-specific coverage. This means that when you move to another state, some healthcare services could be unavailable.
In summary, more affordable coverage is available with a Medical Advantage plan, but it’s important to understand the benefits fully before making a commitment. Hopefully, you now feel like you can make an informed decision regarding Medicare and the plan that will benefit you the most.
If you have any questions regarding the most suitable Medicare option, you can reach out to Michael Cauldwell. He is passionate about Medicare and helping customers find the best option to meet their healthcare needs and will gladly assist you in any way he can.