A well-liked private insurance option for medical care is Medicare. Medicare Advantage does have certain benefits and drawbacks both. Some Medicare Advantage plans can result in fewer provider options, higher expenses, and lifestyle difficulties, while others can give long-term savings, plan flexibility, and better treatment.
The significance of Medicare Advantage, the private plan substitute for regular Medicare, has increased significantly since 2006. In 2022, more than 28 million individuals will be enrolled in a Medicare Advantage plan, representing almost half (48%) of all Medicare-eligible individuals and $55% of all federal Medicare spending ($427 billion) (net of premiums). The average Medicare recipient will have 39 Medicare Advantage plans in 2022, the most selections in more than ten years.
Medicare Advantage: What is it?
Private insurance providers offer Medicare Part C plans, also called Medicare Advantage. They frequently provide extra benefits and combine original Medicare (Medicare Parts A and B) coverage.
Many Medicare Advantage plans provide the following advantages:
- hospitalization and some at-home medical care
- palliative care
- visits to the doctor
- coverage for prescription drugs
- preemptive action
- dental \vision \shearing
- Membership to Silver Sneakers Fitness
Medicare Advantage plan types
There are various Medicare Advantage plan varieties available, including:
- Maintenance of Health Organization (HMO). HMO plans use in-network physicians and demand specialist referrals.
- Favored Supplier Organization (PPO). Depending on whether you use in-network or out-of-network services, PPO plans have varied costs.
- Pay-for-service private (PFFS). PFFS plans are unique payment structures with flexible provider options.
- Plans for Special Needs (SNPs). SNPs assist with the long-term medical expenses associated with chronic illnesses.
- Savings for medical expenses (MSA). Medical savings accounts, or MSA plans, are combined with high deductible health insurance.
- Greater Services
The variety of services that Medicare Advantage plans cover is more flexible than Original Medicare. Medicare Advantage plans can provide extra coverage but are required by law to cover all the same services as Original Medicare. These extra benefits may include gym memberships, on-call licensed nurses, hearing aids, eyeglasses, and in-home medical visits. Part D (prescription medication coverage) is a component of many Medicare Advantage plans.
If you decide to use Original Medicare and want prescription drug coverage, you will also need to purchase a separate Part D plan provided by private insurance firms. Also, more flexible than Original Medicare, Medicare Advantage plans can cover non-medical supplemental benefits like non-emergency transportation to doctor’s appointments, meal delivery to the home, home modifications for members with limited mobility, and non-medical in-home care help with bathing, dressing, and cooking.
- No or Very Low Premiums
While some Medicare Advantage plans have no premiums, many do. Parts A, B, and C are covered by the government, although Part B has a premium that is often taken out of your Social Security. Depending on the plan selected, private insurers may or may not charge an additional premium for Part C. Part C premiums might cost as little as nothing to as much as $300 per month. Depending on your chosen plan, you may be eligible for additional benefits at no additional cost.
- Providers Carefully Selected
Medicare Advantage plans choose low-cost, high-quality providers for its members to reduce costs. Many Medicare Advantage plans, especially HMOs, collaborate with a “care team” that includes doctors, nurses, and physician assistants under the direction of your prominent care physician to deliver coordinated care. A “care team” improves the quality of care and increases patient safety, according to research cited by the Agency for Healthcare Research and Quality.
- Copayments and lower deductibles
The amount you must pay out-of-pocket for medical treatments or medicines before your insurance company starts paying is a deductible. Copayments, often known as copays, are fees you must pay for particular medical services, such as trips to the doctor’s office or an urgent care facility. When you compare the Medicare Advantage plan’s deductibles and copays, remember that these costs will differ from one plan to the next. You can learn about every plan you have access to from a health insurance broker who represents several of them.
- A Cap Out of Pocket
The fact that Original Medicare has no out-of-pocket expense cap is a significant factor. Your out-of-pocket medical expenses under Original Medicare are not capped; they continue to rise over a year and may reach hundreds of thousands of dollars in the case of serious diseases. In contrast, Medicare Advantage plans have an out-of-pocket maximum. No matter how big your actual expenses are, once you have paid that amount, you are done paying for covered services for the year.
- Coordinated Care with Care
You may be able to see any provider for any reason with specific Medicare Advantage plans. However, the majority are health maintenance organizations (HMOs) and demand that you choose a primary care physician (PCP) who will make every effort to connect you to the appropriate provider for the appropriate need at the appropriate time. Your PCP will coordinate your care to ensure you get the right services and aren’t over diagnosed or overtreated.
One of three strategies is used by Medicare Advantage plans to coordinate provider access:
- A single practitioner manages your treatment under an HMO model, referring you as needed to specialists within a predetermined network of providers.
- Without a recommendation from a PCP, you can visit an in-network or out-of-network provider using a preferred provider organization (PPO) model; however, there is a higher deductible or payment if you do so.
- A private fee-for-service (FFS) model where you are generally free to choose any provider who accepts the terms of the plan’s payment
An HMO type plan typically has the lowest premiums and copayments since using a single provider gives them better control over expenses. PPO and FFS plan often have higher premiums. HMO-style plans can give high-quality care and significantly save Medicare and its patients.
7: You Are Free to Modify Your Plans Twice a Year
During the yearly election period for Medicare, all beneficiaries can modify their coverage (October 15 – December 7 of each year). Between January 1 and March 31 of each year, you can transfer to a different Medicare Advantage Plan or return to Original Medicare if you enroll in one and then decide you don’t like the one you chose.
When weighing your Medicare options, you have a variety of possibilities. Compared to Original Medicare, Medicare Advantage plans offer additional services, better care coordination, and more excellent value. The best opportunity to locate a high-quality, easily affordable Medicare Advantage plan is to work with an insurance broker representing many Medicare Advantage plans.