If you are enrolling in Medicare, you may be considering a Medicare Advantage plan and what coverage it can provide you. At Medicare Peace Of Mind, we always want our clients to be fully aware of their Medicare plan options so they can make the most of their coverage. 

With this in mind, we do understand that Medicare Advantage plans aren’t suitable for everyone’s needs, which is why we’re here to explain some of the advantages and drawbacks of a Medicare Advantage plan!

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, which is Medicare Part C, is an alternative option to receive your Original Medicare coverage. Members must 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. However, many Medicare Advantage plans charge little to no monthly premium.

Medicare Advantage plans may provide additional benefits such as fitness memberships or vision coverage. They may also provide Part D coverage for prescription drugs. 

Why Should I Consider Medicare Advantage?

Medicare Advantage plans offer many rewards for members. Compared with Original Medicare, the biggest benefit of Medicare Advantage is that Medicare Advantage plans help reduce out-of-pocket costs. The costs associated with Medicare Advantage vary by plan design and insurance carrier but generally, the overall costs are lower and more predictable. To maximize that value, be sure your doctors and hospital are in-network with your Medicare Advantage plan. If you need a lot of care during a given year, Medicare Advantage can also help because there is a limit on how much you will pay each year. 

Another great aspect of Medicare Advantage plans is that they usually offer additional coverage for services such as vision, hearing, and dental services. Many plans also offer gym memberships and other ways to stay active. If you choose a combined Medicare Advantage and Part D prescription drug plan, you’ll have one card and one plan for all your medical and pharmacy needs.

Because private insurance companies offer Medicare Advantage plans, you will also have access to many of the amenities offered by the plan. These may include case management and care coordination if you have a serious illness or hospital stay. It may also include disease management and support if you have a chronic condition like heart disease or chronic obstructive pulmonary disease (COPD). If your plan includes drug coverage, you may also have access to a mail-order pharmacy that will deliver your maintenance medications right to your home for no additional cost. For those members who enjoy traveling, Medicare Advantage plans usually provide coverage while traveling outside of the United States when urgent or emergent care is needed.

What Are The Drawbacks?

Although there are many benefits, Medicare Advantage is not the right choice for everyone. Most Medicare Advantage plans have a network of providers. That may mean members have to pay a higher out-of-pocket cost to see a non-network doctor, or they may not have any coverage if the plan is an HMO. While Medicare Advantage plans reduce out-of-pocket costs, they don’t eliminate them entirely. 

Members are still responsible for copays, coinsurance, and deductibles if the plan has them. For members looking to reduce out-of-pocket costs even further, a Medicare Supplement plan may be the way to go.

When Can I Make A Change?

There are many options when enrolling in Medicare. You have an opportunity to make a change each year during the Medicare Annual Enrollment Period (AEP), which falls each year between October 15th and December 7th. Additionally, those enrolled in Medicare Advantage have another option to make changes during the Medicare Advantage Open Enrollment Period (OEP) from January 1st through March 31st. Before making any changes, be sure to review all plan costs and benefits as well as the provider networks for each plan.

Medicare Peace Of Mind is here to help you. For assistance reviewing your plan options or to make a change, give us a call at 970-233-0633.