Medicare Advantage Introduction:
There are many different types of Medicare options ranging from Original Medicare to Medicare Supplement to Medicare Advantage. With so many different options, it can be difficult to choose the right plan for you. Find out the Pros and Cons of Medicare Advantage so you can find the right plan for your unique situation. Every year, senior Americans have the opportunity to choose a Medicare plan to address their future health needs. With Medicare, there are essentially four viable options:
- Enroll in Original Medicare
- Get Medigap insurance (also called Medicare Supplement plans)
- Choose a Medicare Advantage plan
- Continue on an employer health plan, with Original Medicare as a secondary payer
This article will help you weigh the advantages and disadvantages of these plans to make a more informed decision. There are many different pieces to consider about Medicare, and this article will help break them down.
Original Medicare Explained
Original Medicare is health care coverage managed by the U.S. federal government. It provides Medicare-eligible individuals with essential medical (Part B) and hospital (Part A) health coverage. With Original Medicare, you will pay your monthly deductible as well as any expenses not covered or approved by Medicare.
Original Medicare is available to:
- People aged 65 years or older
- Certain individuals under 65 afflicted with select disabilities
- Anyone diagnosed with end-stage renal disease (ESRD)
While Original Medicare has helped millions stay healthier without depleting their life savings, it was only designed to provide the basics. In fact, there are many extra health services people find themselves needing that Original Medicare simply does not cover.
Medicare Advantage Plans Bridge the Gaps
Medicare Advantage plans are offered by private insurance companies, and are designed to address the coverage gaps in Original Medicare. These plans bundle Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) and, in many cases, Medicare prescription drug coverage (Part D) as well.
Medicare Advantage plans cap healthcare spending so they can offer major benefits for people who want to control costs and enjoy greater peace of mind. Medicare Advantage plans will have a flat cost per month so it provides consistency while also providing simplicity to your healthcare needs.
Pros and Cons of Medicare Advantage Plans:
- Prescription Drug Coverage
- Extra Health Benefits
- Variety of Plan Types
- Care Coordination
- Limited Service Providers
- Plan Complexity
- Shifting Benefits
- State Specific Coverage
- Need for Referrals
This list is a high level view of some common views on Medicare Advantage plans. To find out how you can make the best decision for your personal needs, contact a licensed insurance agent today.
The Advantages of Medicare Advantage Plans
Now that you have seen the pros and cons of Medicare Advantage, think about your own health needs and what you require. Does Medicare Advantage meet those needs? Everyone has a different health and financial situation, and it’s worthwhile comparing the pluses and minuses of Medicare Advantage plans against Original Medicare.
Prescription Drug Coverage
Original Medicare provides only medical (Part B) and hospital (Part A) coverage. While that can help cover a potentially large amount of healthcare expenses, it doesn’t cover prescription drugs which can potentially have considerable expenses.
Extra Health Benefits
Prescription drug coverage is one of the big reasons why people go with a Medicare Advantage plan. Getting extra health benefits such as dental, vision, and hearing are additional reasons why people choose Medicare Advantage plans. Some plans even offer fitness center memberships, plus allowances for acupuncture, therapeutic massage and more.
Learn more about dental, vision and hearing insurance.
Variety of Plan Types
Medicare Advantage offers different plan types depending on your personal situation. For example, if you have a chronic health condition, a Medicare Advantage Special Needs Plan (SNP) can help with your medical costs. If you want access to a greater range of providers, a Medicare Advantage PPO or PFFS plan may be what you need. A licensed insurance agent is available at your convenience to help you find the plan that’s right for you. Speaking with a licensed agent costs you nothing. And you’re under no obligation to enroll in a plan if you do talk with an agent.
While Medicare beneficiaries are obviously concerned about getting reliable healthcare coverage, costs are also high up on the list of concerns when choosing a plan.
The standard Original Medicare Part B monthly premium for 2022 is $158.50. While some Medicare Advantage plans pay all or part of the Part B premium, most people pay the standard Part B premium amount. Medicare Advantage plans offer a wide range of benefits are often at no extra cost each month.
Depending on their breadth of services, Medicare Advantage plans can offer:
- Monthly premiums ranging as low as $0
- Low or no deductibles
- Low or $0 copays
- Strict limits on the maximum out-of-pocket costs you may pay
If cost savings are important to you, a Medicare Advantage plan is definitely worth considering. The amount you save is also dependent on the type of plan you choose.
Comprehensive healthcare involves seeing a primary care doctor, perhaps a specialist, having lab work, and in some cases having surgery. Coordinating all that care isn’t easy. Usually, the patient must do the legwork to avoid mix-ups, unnecessary expenses, endless phone calls, extra paperwork and so on. Medicare Advantage plans were designed to encompass everything to make healthcare more simple and easy to navigate.
The Disadvantages of Medicare Advantage Plans
A recent poll showed that that 94% of respondents are “very satisfied” with their Medicare Advantage plan based on the selection of providers as well as the care they receive. Still, because individual health needs, lifestyles and finances vary, some people find that Medicare Advantage plans have disadvantages compared to Original Medicare.
Limited Service Providers
Although Medicare Advantage plans offer a broader range of health services, there is a limitation on which doctors you are able to see within your network. With Original Medicare, you are able to see any provider who accepts Medicare’s terms, but Medicare Advantage, you might face higher costs if you go outside your network of approved doctors.
Other Medicare Advantage plan types do give you more provider freedom, although those plans may charge higher premiums, copays and deductibles.
One of the major pluses of Medicare Advantage plans can also be a minus. Due to their popularity, there are many of these plans on the market with a wide range of benefits. This might make shopping for the right one feel overwhelming. To help with this, licensed insurance agents are always ready to assist.
Every year, private companies reevaluate the Medicare plans they offer. This means that you have the option to switch to a different plan every year or stay on your current plan if you are satisfied. In some cases, a company may discontinue your plan. If that happens, you will have a certain time period to enroll in a new plan so you do not lose protection.
These changes in premiums, networks, deductibles, copays and coinsurance are outlined in the Annual Notice of Change (ANOC) which plans mail annually. This document allows you to compare your current plan to others so you can determine if you want to switch plans or stay with the plan you already have.
Why should I care about this?
Medicare Advantage plans have a strong potential to save you quite a bit of money when compared to other plans (some Medicare Advantage plans come with a $0 monthly premium). Millions of Americans already enjoy the benefits of Medicare Advantage plans and those numbers are rapidly growing every year. Speak to a licensed insurance agent now to find out how you can get the coverage you need.
What are the different enrollment dates?
You can change your Medicare health or drug coverage for the up-coming new year during the Annual Enrollment Period (AEP). It runs from October 15 to December 7. You can join, switch or leave a Medicare Advantage Plan or a Medicare drug plan during this enrollment period each year. New coverage begins January 1 if you make a change. If you kept your existing coverage and your plan’s costs or benefits changed, those changes also will start January l.
If you’re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during the Open Enrollment Period (OEP). It runs from January 1 to March 31. Any changes will be effective the first of the month after the plan gets your request.
While Original Medicare offers similar coverage in every U.S. state, Medicare Advantage plans do not always. If you move to a new service area, your current Medicare Advantage plan benefits may not be available.
Need for Referrals
Depending on the options, Medicare Advantage plans often require approval from your primary care doctor before seeing a specialist. This is especially true for Medicare Advantage HMO plans.
Determining the Best Coverage for You
There are many pros and cons for Medicare Advantage plans so make sure consider all the Medicare Advantage plan options available. Although the process may seem confusing, a licensed insurance agent can walk you through all your options and find the plan that’s right for you.
Original Medicare works for millions of Americans. But, with healthcare options increasing and people living longer, millions more are discovering the benefits Medicare Advantage plans can bring.