All Medicare beneficiaries have the option to enroll in a Medicare Advantage plan. When a beneficiary enrolls in a Medicare Advantage plan, they begin receiving their Medicare benefits through the plan. This changes a beneficiary’s cost-sharing, services, and provider network.
Many beneficiaries wonder if they need a Medicare plan. Since Original Medicare does not cover 100% of the cost of your healthcare services, you’ll want to consider enrolling in a plan to help with those out-of-pocket costs.
However, are Medicare plans bad? Are they beneficial? Here is what you need to know about Medicare Advantage plans in 2022.
What is a Medicare Advantage Plan?
Medicare Advantage plans are plans provided by private health insurance companies. Medicare pays these insurance carriers a certain amount each month to provide you with your Medicare Part A and Part B benefits. This means your plan will be managing your care, not the federal government.
Although you must keep Medicare Part A and Part B active and continue paying your Part B premium, you never use Original Medicare as your insurance when enrolled in an Advantage plan. You will only use your Advantage plan when you need a hospital or medical service completed.
Types of Medicare Advantage Plans
The two most common types of Medicare Advantage plans.
1. Health Maintenance Organizations (HMO)
HMO plans to provide coverage for in-network services. This means an in-network provider must complete the services. If the provider is out of network and does not accept your plan, you would pay the total cost of those services.
2. Preferred Provider Organizations (PPO)
A PPO plan provides coverage for in-network and out-of-network services. If you go out of network, you’ll have a higher cost-sharing for that service. Any time you are out of network, you’ll want to verify that the provider is willing to bill your plan.
Benefits of Medicare Advantage Plans
There are many benefits to choosing the Medicare Advantage plans. Many Medicare Advantage plans offer dental, prescription drugs, hearing, and vision coverage. There are many other valuable benefits:
1. No-Cost Fitness benefits
You can avail of fitness memberships under the Medicare Advantage plans.
2. Over – the – Counter benefits
Medicare Advantage Plans cover the OTC healthcare products
3. Transportation
Medicare Advantage Plans also offer you rides to healthcare appointments.
4. Meal delivery
Free meals are also delivered under the Medicare Advantage plans.
5. Personal emergency response system
Medicare Advantage plans offer you the caregiver or emergency services with a click of a button.
6. 24/7 telehealth visits
You can communicate with your healthcare provider using a computer, tablet, or smartphone from your home.
Advantages Of Medicare Advantage Plans
If you choose the Medicare Advantage plan, you will surely get many advantages.
Let’s discuss the advantages of Medicare Advantage Plans in Detail:
1. Convenient Coverage Option
Original Medicare offers just hospital insurance and medical insurance. For additional coverage, you’ll need to opt for Medicare Part D. With Medicare Advantage Plan, you will get all the coverage options under one convenient plan.
2. Personalized Plan Structure
Medicare Advantage provides you with many different plans, and you can choose the one that suits your condition. For example, in chronic health conditions, an SNP Advantage plan will help you bear your medical expenses. Medicare Advantage plans also offer extra services like dental, vision, etc.
3. Cost Saving
Usually, Advantage plans have no premiums and offer no deductibles, but Medicare Advantage Plans set a limit for the maximum cost you pay during a year plan. It also helps you save on laboratory services, medical equipment, etc.
4. Coordinated medical care
You will get coordinated medical care in many Medicare Advantage plans. This means your healthcare provider communicates to coordinate your medical treatment between different services and specialties. This helps to avoid unnecessary healthcare expenses and medication interactions.
Tips for Finding the Best Medicare Advantage Plans
It’s essential to choose the best Medicare Advantage plan for yourself to get the most out of it. However, selecting the one that suits your needs can be confusing, so here are some tips to follow while choosing the Medicare Advantage Plan.
Ask the following questions yourself while choosing the plan:
1. How much is my yearly medical expenditure?
This will help you determine your budget and how much you can pay as premium and out-of-pocket costs. Some plans offer a $0 tip and deductible, while others charge a few hundred bucks.
2. What prescription drugs do I take, and will I need in the future?
If you are already on some medication, make sure that the Medicare Advantage plan you choose includes prescription drug coverage. Search the drug list of the plans before finalizing one.
3. What are the types of coverage I need?
Medicare Advantage plans offer extra services like dental, hearing, etc. Ensure to contact carriers to find out what additional services they are offering.
4. What is my medical condition?
More than 40% of Americans are fighting chronic health issues. Make sure to choose the plan which suits your long-term medical needs.
5. Does my Healthcare provider accept Medicare?
If you have to stick to your current health provider, check what Medicare plans they accept.
6. What is the CMS rating of the plan I am choosing?
The Centers for Medicare & Medicaid Services (CMS) rates the quality of the facilities provided by the Medicare Advantage plans using a five-star rating system. Therefore, you must check the CMS rating of the plans.
Provider Networks
Each Medicare Advantage plan has a network of providers and facilities. When you see a doctor or visit a facility, you’ll want to ensure they accept your specific plan. Your range of providers depends on the type of Medicare Advantage plan you have.
What is the Structure of a Medicare Advantage Plan?
Most Medical Advantage plans do not have a deductible. However, if yours does, you’ll need to meet that deductible before the plan kicks in to help pay for services. Each service has a set copay or coinsurance amount that you pay when you have that service completed. However, that copay or coinsurance will vary with each plan.
Another amount that varies with each plan is the maximum out-of-pocket limit. All Medicare Advantage plans have a maximum limit that caps your services expenses. If your plan denies a service and you pay the total cost, the amount you paid does not go toward your maximum out-of-pocket limit.
Drug Coverage with a Medicare Advantage Plan
Most Medicare Advantage plans include a built-in Part D drug benefit, so you will not need a standalone Part D drug plan if a plan includes drug coverage. Your drug benefit would have its own deductible and cost-sharing. The amount you pay towards your drugs does not go toward your Advantage plan’s maximum out-of-pocket limit.
Your plan also sets preferred, standard, and out-of-network pharmacies. You will want to use preferred and standard pharmacies to get coverage from your plan.
When to Enroll and Change Your Medicare Advantage Plan?
There are specific times and situations when you can enroll in a Medicare Advantage plan. The first time is your Initial Election Period (IEP). This window starts three months before your 65th birthday month and ends three months after. Once that window has passed, you can enroll in an Advantage plan during a Special Election Period (SEP) and the Annual Election Period (SEP).
Each year, insurance carriers make changes to their Medical Advantage plans. The premium, deductible, maximum out-of-pocket, copays, and provider networks can change every year. Due to these changes, you are allowed to change your Advantage plan every year. You can change your plan during the AEP, and your new plan will start on January 1st of the following year.
If you missed the AEP, you could use the Medicare Advantage Open Enrollment Period (MAOEP) to change your plan. This window starts January 1st and ends March 31st each year.
Summary
The details of a Medical Advantage plan, how it works, and when to enroll are important factors that you need to understand before enrolling in a plan. It is essential your doctors are in-network and that your plan covers your drugs. If specific services are important to you, you’ll want to ensure you review what your cost-sharing will be and when you can change your plan if you aren’t satisfied.
