Medicare Advantage is a type of Medicare coverage that combines Part A and Part B benefits into one plan. It’s also known as “MA” or “Part C.” Medicare Advantage plans can offer additional benefits, such as vision, dental, and prescription drug coverage, that are not available with Original Medicare. Most people who have Medicare choose to stay in Traditional Medicare, but about 25% of beneficiaries are now enrolled in a MA plan.
There are two types of MA plans: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). An HMO requires you to use doctors and hospitals within the HMO’s network; if you go outside the network for care, you’ll usually have to pay the full cost. A PPO also has a network of doctors and hospitals, but you’re allowed to see providers outside of the network without having to pay more. However, your costs may be higher if you go out of network for care.
How Much Does Medicare Advantage Cost?
Medicare Advantage premiums vary depending on the plan that you choose. Most MA plans have monthly premiums, but some have annual premiums instead. You may also have to pay a copayment or coinsurance for services received. Be sure to review the plan’s “Evidence of Coverage” (EOC) document carefully to understand all of the costs associated with the plan before enrolling.
What Are The Benefits Of Medicare Advantage Plans?
There are several reasons why people sign up for Medicare Advantage plans says Medicare specialist from ClearMatchMedicare. First, many MA plans offer additional benefits that aren’t available with Original Medicare, such as vision and dental coverage or prescription drugs. Second, some beneficiaries who have limited income may receive a free Part D plan if they enroll in an MA plan. Finally, it can be difficult to manage your health care when you’re enrolled in both Parts A & B of traditional Medicare—Medicare Advantage can make things easier by managing all of the health care billing on your behalf.
Beneficiaries should consider these factors before choosing whether or not to join a Medicare Advantage Plan:
The largest risk is losing access to providers because they don’t accept certain types of Medicare Advantage plans.
Medicare has a history of changing the rules, which can be frustrating if you’re trying to get coverage that works for your needs and budget.
You might have more freedom with an Original Medicare plan because there are no limitations on out-of-pocket costs or where you go for care. If you don’t need additional benefits beyond Part A & B, this could be a better option for you.
There are four main types of Medicare Advantage plans:
Health Maintenance Organization (HMO) plans: HMOs require that you use doctors and hospitals within their networks. Preventive care is usually allowed with no copayment required, but other medical services may have a small co-payment. You generally need to select a primary care physician who can refer you for specialist visits if needed. They will also make referrals when necessary for hospitalizations or emergency room visits as well as follow-up after treatment.
Preferred Provider Organizations (PPO) Plans: PPOs allow members more flexibility in choosing which providers they see including those outsides of the plan’s network without prior approval from Medicare. There are still some restrictions on where you go since all non-emergency services must be obtained within the plan’s network, but it can make finding a doctor easier for some members.
Special Needs Plans (SNP) are designed for people who have certain chronic conditions or require specialized care. These plans offer additional benefits not typically found in other Medicare Advantage options including more comprehensive medical and pharmacy coverage as well as services like personal care, transportation to medical appointments, home-delivered meals, vision & dental checkups, hearing aids/tests/supplies covered 100% of the cost after deductible too! They also cover annual wellness visits with a $0 copayment each time you come in per year. Some SNP plans may include extra requirements such as higher out-of-pocket costs so be sure to ask questions if this is something you are interested in.
Medical Savings Accounts (MSA) Plans: MSAs require members to pay a fixed amount of money each year into a savings account which they can then use to cover medical expenses. The plans also have a high deductible, meaning that you must meet a certain amount of healthcare costs before the insurance company begins to pay anything. These plans may be good for people who want more control over their health care spending and don’t mind taking on more responsibility themselves.
Steps for Choosing:
When choosing between Medicare Advantage plans it’s important to first figure out what you are looking for in a plan. This can vary from person to person, but some things to consider include the type of care you need (inpatient, outpatient, etc.), how often you go to the doctor, whether or not you want prescription drug coverage and what other benefits are important to you.
After that, it’s time to ask questions! Here are a few suggestions:
·What doctors and hospitals are in the network?
·Are there any restrictions on which doctors I can see?
·How much will I have to pay out-of-pocket for services?
·Is there a deductible or copayment for preventive care services like annual checkups or screenings?
·What services are not included in the plan?
·How much will I have to pay for prescriptions?
·What is the annual deductible and how does it work?
Once you have a good understanding of what you are looking for and what questions to ask, it will be easier to find the right Medicare Advantage plan for you.
