Medicare Advantage Plan can be the ideal health insurance policy for people who require a more comprehensive cover for their medical needs. Medicare Advantage Plans are offered by private companies after receiving approval from Medicare.
Here are the important things to know if you plan to buy a Medicare Advantage Plan.
Medicare Advantage Plans include coverage offered by Medicare Part A and Part B (original Medicare). It is sometimes also referred to as Medicare part C.
So, with a Medicare Advantage Plan, you will receive benefits of part A, which covers hospital insurance, part B that offers medical insurance and at times part D covering prescription drugs. Part D cover is often offered at no extra premium costs. The actual benefits can differ from one state to another. For example, Medicare Advantage Plans in Texas may offer some benefits that might not be available in some other states. The differences in benefits are often minor but can be significant for you.
Depending on your provider, you may also receive other benefits such as covers for dental, vision, and hearing care. When you opt for a Medicare Advantage Plan, your Medicare is still valid. The only difference is that you will receive the cover through your Medicare Advantage Plan rather than your original Medicare.
Anyone who is enrolled in the original Medicare (A and B) is eligible for Medicare Advantage Plans provided you live in the same service area of the original plan and do not suffer from end-stage renal (kidney) disease.
Other than kidney failure, you cannot be refused a Medicare Advantage cover on the basis of your current health condition.
There are different types of Medicare Advantage Plans such as HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service), PFFS (Private Fee-for-Service), SNP’s (Special Needs Plans), and MSA (Medical Savings Account).
HMO plans only offer coverage for in-network providers, which can be limited. You will also require a referral from your primary care doctor in case you wish to see a specialist. The network of PPO is wider, and you can see a specialist (with cost-sharing) without your physician’s referral.
Medicare is for people aged 65 or older. So, SNP’s make sense for them. SNP’s is ideal for people who have special medical needs such as round-the-clock care. PFFS offers a wide network of providers in the US who agree to payment terms as per Medicare norms.
POS is a kind of HMO plan where you can see providers outside the network by paying higher coinsurance or co-pay amount. MSA helps you to pay expenses (tax-free) by combining your plan with a ‘special savings account’.
You can enroll for Medicare easily once annually. Enrollment through either IEP (Initial Enrollment Period) or AEP (Annual Enrollment Period) is fine.
IEP ends three months after you become eligible for Medicare (at age 65 or older). You can select or even change your plan during AEP (15 October to 7 December). In this case, your plan will become effective from 1st January next year. During open enrollment periods (1st January to 31st March), you can switch from your existing Medicare Advantage Plan to another. You can even switch back to your original Medicare in the case for some reasons you wish to discontinue with your existing Medicare Advantage Plan. For this, you would need to utilize the time period from 1st January to 14th February.
There is also special consideration for enrollment during election years. Your insurance company can help you provide more information about it depending on your service area.
The cost of Medicare Advantage Plans includes the co-pays, the deductibles, and co-insurance. The cost-sharing or payment terms will apply to all the services included in your cover.
In Medicare Advantage Plans, one cost benefit is also by way of your out-of-pocket maximum amount. There is no percentage involved here. So, if your bill amounts to $40000 for a major surgery, the cost you will incur will be limited to your out-of-pocket maximum (whatever that amount is). You don’t get such cost benefits if you only have the original Medicare.Your provider can help you buy the right Medicare plan as per your unique needs.