If you are enrolled in Medicare or will be soon, you may have noticed that Original Medicare will still leave you with some out-of-pocket costs. For some people looking to add on more coverage, a Medicare Advantage plan may be the right choice.
What Is Medicare Advantage?
Original Medicare consists of Part A, which covers inpatient care, and Part B, which covers outpatient care. Most people are eligible for Part A and aren’t required to pay a monthly premium for that coverage if they or their spouse meet certain qualifications. Members must pay a monthly premium for Part B coverage. Medicare Advantage is also known as Medicare Part C and will provide you with the same coverage as Original Medicare. Members must still continue to pay their Part B premium to Medicare along with any premium that may be charged for the Medicare Advantage plan by the insurance carrier.
Medicare Advantage plans are offered by private insurance carriers and, as already mentioned, will provide you with the same coverage as Original Medicare. However, they may provide additional benefits such as fitness memberships or vision coverage. They may also provide Part D coverage for prescription drugs. These additional benefits are not available with just Original Medicare.
What Do Medicare Advantage Plans Look Like?
There are several different plan types available, and the key features are as follows:
Health Maintenance Organization (HMO) – This type of plan frequently requires selecting a Primary Care Provider (PCP) and may require referrals from the PCP for specialist visits. You will also be required to receive care only from the HMO’s network of physicians and hospitals except in the case of an emergency. This plan type generally has the lowest premium.
Preferred Provider Organization (PPO) – The PPO plan does not require the selection of a PCP and does not usually require referrals for care, although prior authorizations may still be needed for some services. The PPO allows for care both in and out of the network. Expect to pay more out-of-pocket when seeing an out-of-network provider. This plan type typically has a higher premium than an HMO plan.
Private Fee For Service (PFFS) – This plan type usually does not have a network of providers. Instead, any Medicare provider can accept the terms of the plan and see members. No PCP selection is required, and some PFFS plans allow doctors and hospitals to charge members an additional 15% of the Medicare allowed amount.
Medicare Medical Savings Account (MSA) – This plan includes a high deductible health plan along with a savings account to pay for your approved health-related expenses. Your health plan will contribute money to this account.
Special Needs Plans (SNP) – These plans are designed for members with specific circumstances. These may be based on a health condition or a living condition such as residing in a Skilled Nursing Facility (SNF). Only members who meet the criteria for the SNP are eligible to join. Suppose those circumstances change (for example, you are discharged from the SNF). In that case, you may be eligible to enroll in a different plan. SNPs always include Part D prescription drug coverage.
What Should I Look For?
Not all plans are offered in all locations, so be sure to review what plans are available in your area. Fortunately, Medicare Peace Of Mind can help you with this process. When considering a Medicare Advantage plan, it is important to review the benefits and networks offered. For example, if you have a list of doctors, hospitals, and labs that you prefer, be sure to check if they are in the network. Even if the plan has out-of-network coverage, your costs could vary significantly with out-of-network use. Many Medicare Advantage plans also include extra benefits such as vision care, fitness memberships, and more.
As we help you compare the costs of the different plans, we will take a look at the monthly premium along with any deductibles, coinsurance, and copays you may be expected to pay. Suppose the plan you are considering includes Part D prescription drug coverage. In that case, we’ll review any medications you regularly take to see where they fall on the plan’s formulary to determine your expected cost.
How Can I Make A Change?
Suppose your needs change and you want to make a switch to another Medicare Advantage plan. In that case, you’ll have the option to do so each year during the Medicare Annual Enrollment Period (AEP), which takes place from October 15th through December 7th each year. You may also be able to make changes at other times if you qualify, such as during the Medicare Advantage Open Enrollment Period, which is from January 1st to March 31st.
Medicare Peace of Mind can help with all your Medicare needs. For more information on Medicare Advantage plans or to make a change, call us at 970-233-0633.