I know you've heard all about the Medicare Advantage Plan from TV, your neighbor, the mail, and probably a dozen or more phone calls. However, as these are becoming increasingly popular alternatives to Original Medicare, you should know some things.
Private insurance companies approved by Medicare offer Medicare Advantage Plans and must follow the rules set forth by the federal program. They combine the benefits of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), often including additional coverage such as dental, hearing, vision, prescription drugs, and more. Here is a breakdown of what Medicare Advantage offers and how to decide if it is right for you.
How Medicare Advantage Works
Medicare Advantage plans provide all of the coverage of Original Medicare (hospital and medical insurance) but through a private insurance company. The insurance company manages your healthcare services and coverage rather than getting your benefits directly from the government. The plans come with their own network of doctors, hospitals, and providers, so working with a licensed professional is essential to help you find the right plan for your needs.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans, all offering different levels of flexibility in choosing doctors and hospitals:
Health Maintenance Organization (HMO): Requires beneficiaries to use in-network providers and get referrals to see specialists.
Preferred Provider Organization (PPO): This type offers more flexibility in choosing providers and lower costs for in-network care.
Private Fee-for-Service (PFFS): This plan allows you to see any doctor or hospital that accepts the plan's payment terms.
Special Needs Plans (SNPs): Tailored to individuals with specific health conditions or financial situations.
Medical Savings Account (MSA): Combines a high-deductible health plan with a savings account to pay for qualified healthcare costs.
Benefits Beyond Original Medicare
One of the main reasons people choose a Medicare Advantage Plan is the extra benefits.
Original Medicare provides essential hospital and medical coverage, paying 80%; there is 20% left to cover. Medicare Supplements, or Medigap Plans, provide the other 20% coverage. Still, you must pay premiums that increase yearly, and they do not include additional benefits or prescription drugs. Whereas Medicare Advantage provides benefits such as but not limited to:
Prescription Drug Coverage
Dental, Vision, and Hearing
Wellness Programs and Fitness such as Silver Sneakers
Chronic Condition Maintenance
Grocery allowance
and more
Costs of Medicare Advantage
Medicare Advantage costs can vary depending on the plan you choose. You will always have to pay the Part B premium that is deducted from your Social Security, and some plans may have an additional premium, but that is not common. Most Medicare Advantage plans have a $0 deductible. Some may require co-pays or deductibles for certain services such as doctor visits or hospital stays. However, when comparing the costs of your situation with Original Medicare, along with your Supplemental Insurance Premium and Part B Premium, at some point, Medicare Advantage will become the more economical choice while still receiving coverage.
When comparing plans, it is important to seek the help of a licensed advisor. While some have lower upfront costs, others might have higher out-of-pocket costs, and the right advisor will help you to decide which one is better for you.
Medicare Advantage vs. Original Medicare
Both Medicare Advantage and Original Medicare have pros and cons, so choosing between the two really just depends on your individual health needs and financial situation.
Comparison:
How to Enroll in Medicare Advantage
To be eligible to enroll in a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Medicare Part B. You can enroll in a Medicare Advantage plan anytime during the year with a SEP (Special Election), such as if you are new to Medicare, Turning 65, or dually eligible with Medicare and Medicaid, to name a few.
The Medicare Annual Enrollment Period (AEP) is October 15th - December 7th, during which you can switch Medicare Advantage plans, move from a Medicare Supplement to an Advantage Plan, or go back to Original Medicare.
Additionally, there is a Medicare Advantage Open Enrollment Period each year from January 1st through March 31st, during which you can switch Medicare Advantage plans or return to Original Medicare.
Medicare Advantage plans can be an excellent option if you prefer all-in-one coverage, like having all your healthcare services and drug coverage under one plan. They also benefit those who want additional services like dental and vision or have specific healthcare needs that may be better managed through a Special Needs Plan (SNP).
Whether or not you should switch depends heavily on your physicians, network, prescribed medications, and the amount you are currently paying in premiums. If your monthly premium is equal to or higher than a Medicare Advantage Max Out of Pocket (MOOP), then it is advisable to consider making the switch at that point.
Final Thoughts
There are many options for you when it comes to your health and Medicare, and finding a trusted licensed advisor is really important. At Senior Solutions, the Medicare Division of The Bedrock Group, we take care of you as we would our own parents and loved-ones.
Our licensed advisors are available in more than 38 states to assist you either in person or by phone. We offer a thorough complimentary Medicare Benefits Review, which allows you to compare plans from all the leading insurance carriers and select the most suitable one for your needs.
If you would like to have a free review, please go to: www.bedrockfg.com/sheduleappointment
Or call 833-905-1060
We look forward to working with you!
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At The Bedrock Group, we're a Veteran and First-Responder-owned full-service insurance agency. We provide complimentary consultations and no-cost Medicare reviews. Our home office is located in New Albany, IN. We have a Senior Resource Center in Stanford, KY, and a full-service agency in Asheville, NC. We also offer the following services:
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If you have Medicare questions, you can call our team at 502-200-1516. If you want to schedule an in-person Medicare Benefits Review, please call 833-905-1060 or go to bedrockfg.com/scheduleappointment.
If you would like a comprehensive overall review, call 833-905-1060.
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