For some of us age 65 or older, Original Medicare (Part A and Part B ) plus supplemental Medigap insurance provides all the healthcare coverage we need. However, others may want more benefits found in Medicare Advantage plans which technically fall under the heading of Medicare Part C.
Medicare Advantage plans provide Part A and Part B coverage as an alternative to Original Medicare. Medicare pays a fixed amount to private insurance companies, which provide benefits to each beneficiary enrolled in their plans. These companies must provide the same Part A and Part B benefits as Original Medicare but may also cover:
Like Medigap supplemental insurance, most Medicare Advantage plans cap out-of-pocket expenses. In addition, enrollees may have lower monthly premiums and other costs than Original Medicare.
While Medicare Advantage plans provide extra benefits, there are some restrictions:
Medicare Advantage Plans can differ in terms of how they offer benefits:
Medicare Advantage costs differ among plans. Insurers combine benefits to create offerings that differentiate themselves from their competitors.
Some plans pay for all or part of an enrollee’s Medicare Part B premium.
Deductibles vary. Higher deductibles often allow for lower copays or coinsurance.
Medicare Advantage Plans are not allowed to charge more than Original Medicare for some services like skilled nursing care or chemotherapy. Copays and coinsurance for out-of-network services can be higher for insurers with a dedicated network.
There are several options for Medicare beneficiaries to join, switch, drop or make changes to Medicare Advantage Plans. See the Medicare and You handbook for more details.
It usually encompasses the seven months beginning three months before age 65, the 65th birthday month and three months after that.
For Medicare beneficiaries who have Part A and are receiving Part B coverage for the first time during this period, a Medicare Advantage Plan can be joined with coverage starting July 1.
Medicare beneficiaries can join, switch or drop a Medicare Advantage Plan with coverage beginning January 1.
Those enrolled in a Medicare Advantage Plan can switch to another plan, drop a plan or return to Original Medicare.
In most cases, a Medicare Advantage Plan goes from January to December. However, for people experiencing certain life events (moving or losing other insurance coverage), they may be able to join, switch or drop a Medicare Advantage Plan during the year.
If you’re thinking about a Medicare Advantage Plan, first write down all your healthcare priorities. Items on the list could include:
Also, if a specific service, drug or supply item is needed, ask if it is covered by the plan.
A Medicare Advantage plan could be right for you. But, first, it is essential to compare different Medicare Advantage plans. Second, compare these plans to Original Medicare with supplemental Medigap insurance and stand-alone Part D Drug coverage. Once you have completed this thorough analysis, you’ll be better prepared to choose the right plan.
You can learn more about Medicare Advantage plans by visiting the Medicare website or downloading the latest Medicare and Me handbook. Also, look for my future blog posts on Sixty and Me for more valuable Medicare information. For an even deeper dive, check out my Medicare eBook at Living50+.
What questions do you have regarding Medicare Advantage Plans? Have you used it for your health needs? Why did you choose Medicare Advantage over Original Medicare?
Tags Medicare
Dealing with social security and medicare was one of the most difficult and confusing aspects of retiring. Their communication and explanations are confusing and misleading. This whole Medicare advantage thing is part of privatizing services so these companies can profit off government taxpayer money. So now, health premium is deducted from my social security, and I also have health premium deducted from my state pension for an advantage plan. Am I being scammed by my own government?
I think you should visit a reputable Insurance Agent that can review what you have and sort it all out.