Medicare Advantage

A Medicare Advantage Plan, also known as Medicare Part C, is provided by private insurers approved by Medicare. Medicare Advantage Plans provide all of the Original Medicare coverage, and some plans offer additional coverage such as dental, vision, hearing, and prescription drug coverage.

Medicare pays a certain amount for your healthcare to the private insurer providing the Medicare Part C plans. 

Why Choose a Medicare Advantage Plan?

  • Coverage: MA Plans offer all of the coverage provided by Original Medicare. However, most of the MA Plans also include dental, hearing, vision, and prescription drug coverage, as well as fitness program coverage. Other benefits include adult daycare, wellness programs, nutrition programs, and transportation to doctor visits.
  • Convenience: MA Plans allow you to select your benefits through a private insurer, allowing you to shop for most of your plans in one place.
  • Urgent Care/Emergency Care: MA Plans must provide urgent and emergency care coverage outside its plan’s service area.
  • Maximum out-of-pocket: Some Medicare Advantage Plans provides a maximum out-of-pocket limit on how much a Medicare beneficiary will spend on medical expenses; after reaching this limit, your costs will be paid in full. This is beneficial to those who will likely spend more on their medical needs.

Types of Advantage Plans

The most popular types of MA Plans are the Health Maintenance Organization (HMO) Plans and Preferred Provider Organization (PPO) Plans. The HMO Plans are typically cheaper than PPOs, but they lack the flexibility of a PPO.

HMOs have a provider network that beneficiaries will generally have to receive their care and treatment from. If they go outside the network to receive care, the HMO Plan will not provide coverage. You may also be required to choose a primary care doctor within the plan’s network and get referrals to see specialists.

PPO Plans have a provider network, but you are not limited to receiving care within that network. You can go out of the network, but keep in mind that it will cost more if you do so. PPOs also do not require you to choose a primary care doctor or get referrals.

While Medicare Advantage Plans offer the same coverage as Original Medicare and include additional benefits, the plans can still fall short. For example, these plans are nothing like Medicare Supplements. MA Plans do not provide coverage for the costs left behind by Original Medicare, such as deductibles, coinsurance, or copayments. This can lead to your out-of-pocket costs building up over time.

Some of the MA Plans also have restrictions and rules, and to keep receiving coverage, you must follow them. As mentioned above, some plans have provider networks that they require their enrollees to use if they want the coverage. This means if you travel or move, you will not receive coverage, or you will need to find new coverage within your area. The only exception to receiving care outside of your plan’s service area or network is if it’s an emergency.

Medicare Advantage Eligibility

To be eligible for the MA Plan, you must have already signed up for Original Medicare. Once you sign up for Medicare Part A and Part B, you are usually eligible to sign up for the Medicare Advantage Plan, as long as you live in the Medicare Advantage Plan’s service area and don’t have End-Stage Renal Disease (ESRD).

However, in some cases, you may be able to sign up for a MA Plan, even if you are suffering from end-stage renal disease. For instance, you may be eligible for a Special Needs Plan (SNP).

Joining a Medicare Advantage Plan

There are several factors that go into choosing the right Medicare Advantage Plan. Consider things about your long-term healthcare needs and which MA Plan suits your needs best. Also, determine how much you can afford to spend on your healthcare monthly and annually. Ensure to consider the out-of-pocket maximum for your plan.

If you want to know more about Medicare Part C plans or find healthcare coverage that may fit your needs, contact Great Nation Insurance’s experienced Medicare experts today.

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