Medicare Advantage Plans
The Medicare Advantage is another way of achieving the benefits that come with Original Medicare. After you register for an Advantage plan, a private insurer, approved by Medicare, offers you the required coverage.
The majority of Advantage plans bring along better benefits than Part B and Part A of Medicare. Regular dental checkups, coverage for prescription drugs being some examples.
If you need deeper insights on Medicare Advantage plans and want to find whether or not they’re for you, read in full.
To be able to register for the Advantage plan, one must be living in an area that comes under the service region of the plan. Along with that, you must also have Parts A and B.
Advantage Plans bring the benefits of your Traditional Medicare Plan
In most cases, you’ll get the option of how you want the Part B and Part A benefits.
- Either you can keep your Original Medicare and enjoy the Part B and Part A benefits. Several people get automatically registered with this program. However, your traditional Medicare plan won’t offer you coverage for prescription drugs, with the exception of some situations.
- It also does not offer coverage for regular dental checkups.
- Or you can enjoy the Part B and Part A benefits from your Advantage plan. The majority of Advantage plans offer you prescription coverage. Several plans also offer you additional benefits such as fitness programs, regular dental coverage, and meal delivery in certain cases.
- However, not every Advantage plan offers additional benefits too. You can buy one of these plans from a private insurer who’s in partnership with Medicare.
Benefits of Advantage plans
The Advantage plans can help you cover the Part A and Part B services of Medicare. Here are the services you can expect coverage for:
- Required care at a nursing facility or hospital
- Doctor visits
- Outpatient Surgeries.
- Urgent and Emergency Care
- Medical Equipment
- Home health services
- Diagnostic tests
- Ambulance services
Things to note:
- For you to get the coverage, all of the above services must meet the Medicare requirements.
- You might also have to pay a coinsurance, copayment, and a deductible.
- The Advantage plans may also require you to avail of the services from providers within the network.
Other benefits you can enjoy with Advantage plans
The highlighting feature of Advantage plans is the coverage for prescription drugs.
The Advantage plans quite frequently offer benefits such as coverage for hearing, dental and vision care. Other benefits that have been recently added are aide services, transportation, along with telemedicine.
All in all, you can get prescription coverage, vision, dental, hearing coverage with a single Advantage plan from a single insurer. Another benefit you can expect from such plans is a gym membership.
Medicare Advantage: Cost of coverage
When you register for an Advantage plan, you’ll still have to pay the premium Part B every month.
Certain plans come with a premium, while some don’t. Similar to the traditional Medicare plan, Advantage plans need cost-sharing.
It means you’ll have to pay a portion of the service that you used.
And the rest of the part will be paid by the plan.
Some Advantage plans also come with a yearly deductible that you need to pay before getting your coverage.
Several advantages plan also include copayments which you need to pay for the services you’re getting the coverage for.
There’s a coinsurance which you may have to pay for particular services.
But every Advantage plan comes with a max out-of-pocket expenses limit for the Part B and Part A services for that year. It means if you spend a set amount of money from your pocket and need more services in that year, the plan will cover your costs. For 2021 this limit was $7,550.
Advantage plans: Plan types and provider networks
The Medicare Advantage Plans usually have a network of providers, i.e., doctors, medical suppliers, and hospitals, etc. This partnership with healthcare facilities helps the advantage plans keep the plan costs low for the enrollee.
You must know that some Advantage plans have a provider network while some don’t. Here are some common types of Advantage plans: –
MA HMO: When you choose HMO, you can get coverage only if you buy services from a provider within the network. You’ll have to choose a PCP for coordinating your health care and offers you referrals whenever required.
MA PPO: The PPO plans can offer you coverage even if you go outside the network. You may have to pay a bit more for the emergency care services if you buy them outside the service area. However, in this plan, you might not need a referral from your physician.
MA PFFS: With a PFFS plan, you can get coverage from any provider that honors the Advantage plans from your insurer. If the healthcare provider does not accept the plans, you’ll have to pay for those expenses from your pocket.
Advantage plan: Enrollment
If you already have coverage for Part B and Part A of Medicare and live in an area serviced by your Advantage plan’s provider, you can certainly register for an Advantage plan. However, if you are suffering from ESRD, you may not be able to register for an Advantage plan.
But you can use a type of Advantage plan, also known as Special Needs Plans to enjoy the benefits.
Here are some Advantage plans enrollment periods you need to know about:
- You can register for a Medicare advantage when you initially qualify for Medicare which is during the IEP.
- There’s an AEP that runs from Oct 15th to Dec 7th, during which you can register for the advantage plans.
- If you’re already registered with an advantage plan, you can switch back or change that plan during the MA OEP running from Jan 1st to May 31st.
- If you move to some other state, you can also alter your Medicare Advantage plans.