There are so many options out there when choosing a Medicare plan. But why would someone choose a Medicare Advantage plan over the rest? Let’s go over some key points as to why an Advantage plan might be the right choice for some.
First – What are Medicare Advantage Plans?
Medicare Advantage, also known as Medicare Part C, is an alternative way to get your Original Medicare (Part A and Part B) coverage. These plans are offered by Medicare-approved private companies that must follow a set of rules set by Medicare.
Medicare Advantage plans include offering the same benefits as Original Medicare, but your costs will vary from plan to plan. That’s because there are many different types of Medicare Advantage plans, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), special needs plans (SNPs), private fee-for-service plans, and Medicare Savings Accounts. Not all types of plans are available in all areas or even to all Medicare beneficiaries, so doing your homework is necessary.
Why Someone Might Choose a Medicare Advantage Plan
Now that you know the basics of Medicare Advantage plans, it’s time to get into the details. After all, you need to know how a plan works and what it can (or can’t) provide you to see if you think it’s the right fit for you. So here are some reasons someone might choose a Medicare Advantage plan:
You Can’t be Turned Down
If you have a pre-existing condition, rest assured that Medicare Advantage plans can’t charge you more or deny you coverage.
This is something to think about if you have a pre-existing condition and are going to enroll in Medicare. If you go with Original Medicare and decide you want supplemental health insurance, also known as Medigap policies, insurance companies can deny seniors’ Medigap applications because of a pre-existing medical condition. Advantage plans don’t ask health questions on their applications, so you know that you can’t be denied based on your health.
Low Monthly Premium Payments
With Advantage plans, you have more out-of-pocket expenses, so carriers often offer low or even $0 plan premiums. Be aware that you’ll still continue to pay a monthly Part B premium to Medicare even with a Medicare Advantage plan, but the low or no costs of additional premiums can save you. It might be worth it, especially for some seniors who are healthy and might not visit the doctor often or those on a strict budget.
Advantage plans can also provide a financial safety net for many as they set an annual out-of-pocket limit. If your costs reach the limit, then your plan covers 100% of your Medicare-covered healthcare costs for the rest of the year. This is different than Original Medicare, as Part B pays 80% of your outpatient services. The leftover 20% then falls onto you, and there is no cap on how much that 20% can become. With a Medicare Advantage plan, it can be relieving knowing no matter how much your potential medical services may cost, they will never exceed a certain amount.
Again, with an Advantage plan, you’ll be spending more out-of-pocket. But in return for that, some carriers offer additional benefits with their plans. This can include:
- Dental coverage
- Vision coverage
- Hearing care
- Health and wellness packages
- Coordinated care
- Transportation to medical appointments
- Virtual telehealth doctor visits
- Gym memberships
While carriers are not required to provide these, and what’s offered can change year to year, many carriers have been adding extra benefits to their plans to remain competitive.
You Can Switch Every Year if the Plan isn’t Right
If you sign up for a Medicare Advantage plan and decide it’s not right for you, there’s an opportunity to switch every year. You don’t have to be stuck with a plan you don’t like for too long!
Every September, you receive an Annual Notice of Change letter detailing the changes to your Advantage plan in the new year. If you’re not keen on the changes, you don’t have to accept them. During the Annual Enrollment period from Oct 15 to Dec 7, you can switch or drop your Advantage plan. This can help ensure your current plan is the most suitable for your healthcare needs and budget.
Networks are Not a Deal Breaker
One of the most controversial parts of Medicare Advantage plans is they have network restrictions. For some people, this can be a massive turn-off if the freedom to see whoever they please is essential to them or if they need to see the doctor they’ve had for years.
For others, though, working with network restrictions is not a deal breaker. Some might not have problems needing to switch doctors or pharmacies. And sometimes, plan networks aren’t small, and people find themselves in an extensive network with plenty of options for healthcare providers.
Let’s Find the Right Plan for You
Medicare Advantage plans, Original Medicare plans… there are a lot of options out there for you to choose. Not sure what plan you should choose? Jeffery Insurance is here to lend a hand. Our team is here to help you understand Medicare and answer any questions you have about its coverage and your plan. We are based in Scottsdale but are happy to assist you no matter where you are in Arizona. We are Arizona’s health care resource!