Medicare Advantage is an insurance option that is not for everyone but can be an excellent choice for those who can afford it. This article helps explain the different Medicare Advantage plans. It provides a complete guideline for benefits, costs, coverage, and many other options.
Table of contents
- What Are Medicare Advantage Plans?
- What Are Some Tips to Qualify for a Medicare Advantage Plan?
- What Are The Cost of Medicare Advantage Plans?
- When Can You Join a Medicare Advantage Plan?
- Comparing Medicare Advantage Plans
- Medicare Advantage Can Affect Original Medicare Benefits
- Find the Best Medicare Advantage Plan
Senior Affair is here to help you make the best decision about Medicare Advantage.
What Are Medicare Advantage Plans?
Private health plans, also called Medicare Advantage or Medicare Part C, provide a suitable recipient for Original Medicare (Part A and Part B). In Medicare Advantage, about 30% of all new Medicare recipients enrolled. Like Medicare, it is not a substitute for supplemental medical insurance but is different from traditional Medicare with the flexibility to provide more services.
You can have Part A Medicare (Hospital Insurance) coverage and Part B Medicare (medical insurance) with a Medicare Advantage plan. The Medicare Advantage plan should offer health insurance equal to the original Medicare according to rules and regulations. But most of them provide more benefits and coverage. It's a note that choosing a Medicare Advantage plan will not eliminate you from Medicare.
Even with this, you still maintain the protections and rights that the government guarantees. Private insurers also sell this coverage. So it's different from Bidencare. In any case, if you qualify for Medicare, it doesn't mean that you are not suitable for Bidencare regardless of your income.
For most people, the most common plans are:
Private Fee-for-Service (PFFS) plans.
- Preferred Provider Organization (PPO) plans.
- Health Maintenance Organization (HMO) plans.
These plans are offered in most areas, and people can choose one.
They offer some plans in select markets, including Special Needs Plans (SNP), Medical Savings Accounts (MSA), and HMO Point-of-Service plans if you search for a Medicare Advantage plan as a substitute for Medicare.
What Are Some Tips to Qualify for a Medicare Advantage Plan?
To enroll in a Medicare Advantage plan, candidates should meet the following conditions to qualify.
- You qualified for Medicare Part A and Medicare Part B.
- You live where Medicare Advantage or MAPD plan services are available.
- You are not suffering from End-Stage Renal Disease (ESRD).
What Are The Cost of Medicare Advantage Plans?
Like Part B, the premium is that the Cost of minimum Medicare Advantage is the same for the 2021 plan year, which is $144.30. So you'll pay a bit more if your yearly income is more than $85,000.
Maybe where you live, some Medicare Advantage plan premiums are zero dollars ($0.00)
Your total premium medical care plan is based on Medicare Part B. The prices offered to you will depend on many factors, including where you live, competitiveness, health network availability, and cost of living.
While comparing plans, don't only look at only the cost factor. The following questions you should think of while shopping for plans are:
- What kind of health services do you require and when?
- How much do you spend annually on coinsurance, copayments, and additional insurance coverage?
- Does your plan have a deductible? If so, how large is it?
- Is there a deductible for most of their services?
- What will each visit to the doctor cost, and what in-network or out-of-network services?
- Apart from Medicare Part B, does your plan have a monthly premium?
- Does this plan pay for your Part B premium?
- How much is the maximum out-of-pocket expenses (annual) for the plan
- Does this plan include a Part D prescription drug plan like most others?
- What additional benefits do they offer for each plan, like vision, hearing, and dental coverage? Do you want/need these services? Consider the cost of these benefits.
There are so many things to consider, so you should research the various benefits of the plans. Take a look into the rules and costs of the program you want to choose according to your needs. You can also call Medicare for assistance if there is any confusion.
When Can You Join a Medicare Advantage Plan?
In contrast to Medigap, which doesn't have a particular enlistment period, you are required to sign up for a Medical Advantage (MA) Plan or Medicare Part D Plan (PDP) during the yearly election period (AEP) or your initial enrollment period (IEP). It would help to mark these open enlistment period dates on your calendar.
Medicare's annual enrollment period is at the same time every year. It begins on October 15th and finishes on December 7th.
During AEP, you can un-enroll from your current MA or PDP plan and sign up with another policy. If this is your first time signing up, it will be your responsibility to use the available resources to get details about MA Plans.
Besides AEP, you have your initial enlistment period. Your IEP happens once when you initially meet all requirements for Medicare benefits. For a large portion of us, our IED occurs when we turn 65, yet it can also be the point where we meet all the requirements for Medicare because of a handicap or ESRD.
Your IEP is a 7-month period that begins three months before you turn 65, incorporates the month you turn 65, and finishes three months after turning 65. Usually, the Social Security office will send you reminders.
If you qualify for Government healthcare because you are disabled and under 65, you can pursue a Medicare Advantage Plan or Medicare prescription drug plan. Your Medicare coverage starts 24 months after getting Social Security Disability. Your opportunity to try out a MA plan is open through the 27th after getting Social Security benefits.
Comparing Medicare Advantage Plans
When you're shopping for health plans, make sure to consider deductibles and medication co-pays as much as the premium's expense. Unfortunately, the public authority does not control the rates. Although many preferred health plans are covered by Part A and Part B premiums, your cash-based costs will vary with each program.
Remember that Medicare Part C consolidates your Part A and Part B choices and provides Part D drug inclusion alternatively. It's called the Government health care preferred position because, by and large, it is a cheaper option in contrast to Original Medicare. So be aware of how the backup plan sets administration limits; this is how they control costs.
Health Care Providers and Medicare Advantage
All insurance carriers and Medicare Advantage plans offered are unique. Most plans arrange your medical care through a primary physician in an HMO plan. They deal with your daily necessities. You should use the specialists and clinics inside the plan's network in this kind of plan.
PPO-based Medicare Advantage plans are more adaptable. For example, a PPO plan allows you to get medical care from any qualified physician. Physicians can choose to recognize your plans' terms, conditions, and installment rates each time they perform services.
Medicare Advantage Can Affect Original Medicare Benefits
If you pick a Section C plan, you will stay in the Medicare Program and give up your regular Part A and B inclusion. You continue having Federal health insurance rights and security. You can switch back to the original Medicare later if you choose the Part C plan and fall short of your necessities.
Know that Part C plans are different for each city and state. You should invest some time in choosing the proper plan. For example, if you have End-Stage Renal Illness, by and large, you won't be allowed to utilize a Part C plan. Medicare Advantage isn't as complex once you understand the essentials. Before picking medical service protection, ensure you fully comprehend the plan benefits and charges.
Find the Best Medicare Advantage Plan
Here are seven hints to help you decide on an ideal plan that will make finding the best Federal health insurance plan more straightforward.
1.) Research and comparison of yearly plans
The most noteworthy mistake we see every year is seniors automatically keeping the plans they saw the previous year or many years ago. This can be costly since health plans change from year to year. Carriers can change their plan's expenses yearly (the drug list), including your deductibles and anything else. Additionally, the plan's quality rating changes, which we'll get to next.
In this way, if you don't research your current plan's charges, deductibles and benefits compared to the competition, you could get short-changed, which is particularly common for new health plans on the market. New health plans are notorious for raising costs and bait switching their benefits to convince seniors to choose their policy.
2.) Take a Look at the Quality Rating
Every year Medicare and Medicaid Services publish an outlined 5-star rating on each carrier based on the previous year's performance. Many people fail to look at the ratings, but we feel it's critical to do so. The rundown rating depends on various significant components that will give you a very accurate snapshot of the features and benefits of the plan. For wellness plans, CMS rates how the carrier oversees:
- Promoting staying fit and healthy, performing screening, tests, and vaccinations at necessary times
- Handle condition if there is any chronic disease
- Customer Services with health plans
Plans related to drugs are also similar; CMS assesses:
- Customer Service with Drug plans
- Objections and exchange with Drug Plan
- The accuracy and safety of Drug Pricing
3.) Know the solution to your problem
We don't have to tell you that prescription drug costs are rising yearly. They've made some protections for seniors over the years, but the price of a
Various factors will affect what you pay at the pharmacy. First, your medication dosage, earlier approval limits, treatment necessities, co-pays, supplemental insurance, the pharmacy you use, and many different variables combined. The truth is that your specific treatment and prescription plan, dosage, drug store, and more will change what you pay.
4.) Don't Be Afraid to Switch Pharmacies!
The Walgreens down the road may be more convenient, but the CVS at the opposite part of town or your nearby market could spare you a wad of cash. The purpose behind this is straightforward: insurance plans have special pricing agreements with certain pharmacies, which constantly change. Thus, in addition to the fact that you need to shop for the different plans with the best costs for the medications you take, you should also find the best pharmacy for that plan. Most importantly, you may need to switch to an alternate drug store for the best cost.
5.) Call Your Doctor's Office
Your primary care physician's office knows what plans they accept. So feel free to call them and ask about a suggested health plan, which helps you increase your chances of being accepted by your preferred doctors.
6.) Pay attention to the cost of being seen by the doctor
So far, we've emphasized your prescriptions. But for most seniors, the cost of seeing your primary care physician or going to the ER could whittle down their spending plan if they choose the wrong health plan!
We feel that a co-pay (fixed sum) is better than a coinsurance (based on the service). With a co-pay, you will know what you owe when you see your PCP or visit the ER. With a co-protection, you could look at a bill for up to 20% of the actual expense.
7.) Medigap may be the best Medicare Plan
If you currently have Original Medicare or thinking about it, odds are it's because of cost and your spending plan. We understand. Maybe there's a possibility you should consider?
If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.