What is Medicare Advantage? You could be missing out.
Written by Nic Bailey on Jun. 14th 2022
Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies. Medicare Advantage is an alternative to traditional Medicare by combining original Medicare with additional benefits such as prescription and dental coverage. Insurance companies that offer Medicare Advantage plans contract with the government to provide health insurance benefits to those people who are enrolled in Medicare Part A and Part B. Medicare Advantage plans must provide the same benefits as Original Medicare, Medicare Part A which covers hospitalization, and Medicare Part B which covers doctor’s visits. Most Advantage plans generally have Medicare Part D, prescription drug coverage, as part of the plan. Many also include additional benefits that are not a part of original Medicare such as dental care, eye and vision care (including glasses), hearing benefits and hearing aids, and a monthly allowance for over-the-counter benefits.
Here are some of the Pros and Cons of Medicare Advantage plans.
Pros:
--Additional benefits and coverage, toward dental, hearing, and vision coverage.
--Lower premiums or potentially $0 premiums. Many plans have $0 monthly premiums.
--There are limits set on how much you may have to pay out of pocket for hospital and medical coverage.
Cons:
--Less freedom to choose your medical providers. Many plans are HMOs where you have to receive treatment in the plan service area. Other plans are PPOs, which give the flexibility to see doctors in or out of network.
--They do require that you live in the plan’s geographic area.
--Limited ability to switch back to a Medicare Supplement Insurance policy.
Medicare Advantage vs. Original Medicare
Some Medicare Advantage plans have provider networks that limit where you can receive coverage. If you choose to go outside the network, you may be required to receive a referral and the coverage may cost more than if it was in the network. Original Medicare allows you to use any doctor or medical facility that accepts Medicare. However, with Medicare Advantage plans you often pay less. Sometimes the Medicare Advantage plan may have a $0 premium. Along with $0 copays to see doctors within the network. Medicare Advantage plans also have a maximum out-of-pocket limit for covered care.
Medicare Advantage vs. Medigap
Medicare Advantage plans can be confused with Medicare Supplement, also called Medigap, both plans are offered by private insurance companies. Medigap plans cover the “gaps” in Original Medicare by covering the 20% of covered charges not picked up by Original Medicare. Most or all of your medical care will be covered by your Medigap plan. You will pay an expensive monthly premium for Medicare Supplement with those premiums increasing as you get older. Medicare Advantage plans are bundled to include the same coverage as Medicare Part A, B, and D with lower costs than Original Medicare. Plus they include coverage and additional benefits for dental, hearing, and vision coverage, along with an allowance for over-the-counter benefits. Many Medicare Advantage plans are offered at no premium beyond your required Medicare Part B premium. Depending on your plan you may have $0 copays or some small copays when you see your doctor or receive medicare care. Also, Medicare Supplement policies are standardized so it’s simple to compare plans. Each Medicare Advantage plan is different, so finding what plan provides the most benefits and fits your needs the best is important. You are not able to have both a Medicare Advantage or Medicare Supplement plan at the same time.
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