Do Medicare Advantage Plans Truly Give You an Advantage?
This week we are continuing our conversation on Medicare plans and enrollment. When you enroll for Medicare, you will have two main options: Original Medicare or a Medicare Advantage Plan. Medicare Advantage plans, or “Part C” plans, are a bundle plan that includes Part A (hospital), Part B (medical), and typically Part D (prescription), whereas Original Medicare only consists of Part A and Part B. Medicare Advantage plans are offered by Medicare-approved private companies and they are required to follow rules set by Medicare. Does this sound like a confusing alphabet soup? Well, we will break down the differences a bit more for you.
Some Advantage plans may have lower out-of-pocket costs than Original Medicare. However, you will generally be required to use providers that are in the plan’s network. Many Advantage plans also offer extra benefits that Original Medicare doesn’t cover, like vision, hearing, and dental. To compare the most common types of Medicare Advantage plans, click here.
Medicare Advantage Plans Require You to Use In-Network Providers
With Original Medicare, you can go to any doctor, hospital, or nursing home that accepts Medicare. On the other hand, with Medicare Advantage plans, you will need to see a doctor that is in your plan’s network. So, if you really like your doctor, you should ask if they accept Medicare Advantage plans (and which ones) before making the switch from Original Medicare. Another important consideration when exploring Advantage plans is that you will likely have to get a referral from your primary physician before you can go see a specialist.
In addition , there are also Medical Savings Account (MSA) plans. These plans are like Health Savings Account Plans available outside of Medicare. You can choose your health care services and providers (MSA plans usually don’t have a network of doctors, other health care providers, or hospitals).
Is there a cost difference?
With Original Medicare Part B Medical services, you typically pay 20% of the Medicare-approved amount after you meet your deductible. With Medicare Advantage plans, the out-of-pocket costs can vary depending on the services. You may also have to pay a premium for a Medicare Advantage plan, in addition to a monthly premium for Part B.
The good news is, for Medicare Advantage plans, there is a yearly limit to what you will pay out-of-pocket for Medicare Part A and Part B covered services. So, after you hit the plan’s limit, you won’t have to pay for additional Part A and Part B covered services for the rest of the year. But, unlike Original Medicare, you can’t buy or use supplemental health insurance coverage when you have a Medicare Advantage plan.
Medicare Advantage plans must cover all the medically necessary services that Original Medicare covers, and plans can offer other benefits that you can’t get through Original Medicare alone. For example, prescription drug coverage is built-in to most Medicare Advantage plans. Plus, Original Medicare will still cover the cost of hospice care if you ever need it.
Other extra benefits may include transportation to doctor’s appointments, adult day care services, and other health-related services that promote health and wellness. However, you should be careful to check what benefits are offered with each Advantage plan, and which you qualify for, before you select a Medicare Advantage plan. The good news? You have the option each year to continue with your current Advantage plan, choose a different Medicare Advantage plan, or switch to Original Medicare.
Are they really “disadvantage” plans?
While Medicare Advantage Plans seem to have many benefits that Original Medicare is lacking, Medicare Advantage plans require “prior authorization” from the plan for many healthcare services. Plus, providers can join or leave a Medicare Advantage plan’s network at any time. Your specific Advantage plan can also change the providers in the network anytime. If this happens, you might find yourself having to choose a new provider. Remember, you generally won’t be able to change plans during the year if this occurs.
Keith Nabb, founder of Affordable Medicare Solutions, cautions, “If you are using the Advantage system, you must make sure that your providers are in-network. PPO Plans allow you to go in or out of network fairly easily. But the HMO plans are restrictive and do not allow out of network providers typically.”
In addition, if you need rehabilitative care, many Medicare Advantage plans limit your provider options. This means that you would be limited to in-network skilled nursing facilities, and if a particular skilled facility is out-of-network, they either wouldn’t accept you or you would have to privately pay without the assistance of Medicare or your plan.
Choosing the Option that is Right for You
You should explore both Original Medicare and Medicare Advantage plans fully before deciding. For more information to help you choose between the various options, visit the Center for Medicare Advocacy here.
When comparing plans, Nabb advises, “everyone needs to at minimum review their drug coverage annually. Using the www.Medicare.GOV website you can do this quickly.” A change in prescription coverage may impact your choice of plans.
Do you need help deciphering which plan might work best for you? Call Hurley Elder Care Law at 404-843-0121 and we can refer you to a Medicare specialist to discuss your needs.
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