Medicare Advantage Plans
Medicare Advantage plans, also commonly known as Medicare Part C, are designed as an alternative insurance option for those enrolled in Medicare Part A and Part B. In addition to looking into options for Medicare Supplement plans, you may want to look into Medicare Advantage plans. Once you do, you might find that an HMO, PPO, or another type of Medicare Advantage plan is right for you. Then, instead of relying on the basic Medicare benefits from the federal Medicare program, you can enjoy even more savings on out-of-pocket expenses for your necessary healthcare services and medical care, from skilled nursing to emergency room visits, doctor’s appointments, and more.
Are Medicare Advantage Plans Bad?
Suppose you’re going to be eligible for Medicare soon or have already signed up for Medicare Part A and Medicare Part B. In that case, you might be interested in your Medicare Advantage plan options. Additionally, you could be concerned about any upcoming changes you need to know about as someone hoping to become a beneficiary of one of the MA plans available in your area.
Some of the things that you may want to be aware of are:
- Policy premiums have decreased steadily for Medicare Advantage beneficiaries over the past few years, and many pay $0 premiums outside the Part B deductible. So naturally, before buying a Medicare Advantage plan, you should compare rates and insurance company options to find the best deal.
- Significant changes have been made in the past few years that will finally make it possible for beneficiaries to enjoy some home health coverage through their Medicare Advantage plans. Even non-medical, in-home options may be provided.
- Starting in 2020, insurance companies that provide Medicare Advantage plans were able to add some supplemental non-health-related benefits for certain beneficiaries, such as providing help with making structural changes to the home when needed. For example, this is designed to help those who might need help widening doorways or installing ramps for their homes.
- The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insures that offer Advantage plans.
When Can You Enroll in a Medicare Advantage Plan?
You can only enroll in a Medicare Advantage plan during a Medicare Enrollment Period. These are the different Medicare Advantage enrollment periods you should know about:
- Medicare Initial Coverage Election Period ICEP – This period is triggered when you’re first enrolled in Medicare Part A and B. This is your first chance to sign up for a Medicare Advantage plan.
- Medicare Annual Election Period AEP – Every year, everyone who is a beneficiary of Medicare Part A and B can make changes during this AEP. This period runs from October 15 to December 7 every year. You can sign up for, change or disenroll from an MA plan during this time.
- Medicare Advantage Disenrollment Period MADP – If you are unhappy with your Medicare Advantage plan and want to return to Original Medicare, you can do so during this period.
- Medicare Advantage Open Enrollment Period MA OEP – The MADP has replaced this period.
- Medicare Special Election Periods SEP – Special election periods are triggered for those dealing with special circumstances who might need to change their policies. For example, if you move or lose coverage through your current insurance company, an SEP will be triggered so that you can sign up for a new plan. The SEP is designed so you will not have to be without insurance if you don’t want to be.
What are the Best Medicare Advantage Plans?
Shopping for a Medicare Advantage plan can be confusing and tricky when you have to worry about coinsurance, copayments/copays, deductibles, networks, and more. This is a quick guide to help you understand more about the different plans available for you.
Best for network freedom: PPO – Preferred Provider Organization (PPO) plans
- PPO Medicare Advantage plans offer a little more flexibility than HMO Medicare Advantage plans, although there are still networks for you to be aware of.
- You’ll have out-of-network coverage in emergency situations. You can also use out-of-network providers in non-emergency situations, but your out-of-pocket costs will be higher. This is because you get a discount when you visit in-network providers.
- You don’t have to choose a primary care doctor (PCP) with this type of plan.
Best for lowest cost: HMO – Health Maintenance Organization (HMO) plans
- Premiums are often the lowest with these policies. Some beneficiaries don’t have to pay a premium at all.
- You have to have a primary care doctor, and you’ll need referrals from this doctor if you want to see specialists.
- You will have out-of-network coverage in emergency situations, but you won’t in non-emergency situations.
Best for chronic health conditions: Special Needs Plans (SNPs)
- Special Needs Plans SNPs are Medicare Part C plans designed for Medicare Part A and Part B beneficiaries with certain chronic health conditions or institutional conditions. For example, those who have end-stage renal disease ESRD are eligible.
- These policies always include Medicare Part D prescription drug coverage.
What are the best Medicare Advantage Companies?
As an Original Medicare (Medicare Part A and Part B) beneficiary who is interested in Medicare Part C, you may find these statistics interesting:
- Medicare Advantage enrollment has almost doubled in the past decade.
- Most people with Medicare Advantage have their plans through a few top companies: UnitedHealthcare, Humana, and Blue Cross Blue Shield. But, of course, there are other popular providers, too, such as AARP, Cigna, and Aetna.
- Approximately half of Medicare Advantage beneficiaries do not pay a premium for their policies other than the Medicare Part B premium. Those who pay higher premiums may enjoy more freedom and flexibility.
Do Medicare Advantage Plans Cover Prescription Drugs?
MADP plans are Medicare Advantage plans that include Medicare Part D prescription drug coverage. Nowadays, most Medicare Advantage plans include some prescription drug coverage for their beneficiaries. However, this is not always the case, so look for this when comparing policies.
These are a few things you’ll want to know about prescription drug coverage as a part of your Medicare Advantage plan:
- Rates are typically higher than for policies that don’t include prescription drug policies, although the savings are typically worth it.
- You may face a penalty if you don’t sign up for a Part D plan when you’re eligible. Purchasing a Medicare Advantage plan with a Part D policy will allow you to avoid this penalty.
- Each company offers a different formulary for prescription drug coverage, and different companies have different prescription drug tiers. Compare these things before signing up for a plan so that you will know what is and is not included.
Do Medicare Advantage Plans have a Network?
Although Medicare Advantage plans have many benefits, many beneficiaries are concerned about network restrictions. As long as you understand these restrictions and sign up for the right plan for you, though, you might find that they aren’t a big deal.
- In-Network vs. Out-of-Network – With a PPO, doctor or hospital visits will still be covered outside your provider’s network, but you will generally have to pay more. With an HMO, on the other hand, you will not have coverage outside of your network unless it is an emergency (such as if you need to go to the hospital for an emergency). This is a little different from Original Medicare (Medicare Part A and Part B) since Original Medicare does not have network restrictions.
- Traveling With Your Plan – When you’re traveling with an HMO or PPO, you will be covered in an emergency when you’re traveling. With health maintenance organization HMO plans, you won’t be covered for non-emergencies while traveling. With preferred provider organization PPO plans, you can still enjoy some out-of-network benefits when you’re away from home, although, again, you may have to pay more in out-of-pocket costs.
- Moving Across State Lines – If you move to another state, you’ll need to sign up for a new health insurance plan, or you’ll need to switch back to Original Medicare coverage (with or without a Medigap plan). Luckily, an SEP will be triggered so that you will have the chance to do so.
Added Benefits of Medicare Advantage Plans
One great thing about Medicare Advantage plans in comparison to Medicare Supplement policies (like Plan C, Plan F, or Plan G) is the fact that wellness programs and benefits are often included with these Medicare plans without an additional monthly premium. For example, routine vision and dental costs aren’t included in any of the Medicare Supplement plans (including more comprehensive options like Plans C and F or high deductible Plan F). Still, many MA plans do include these benefits. These are some of the perks that might be available with health plans through popular private insurance companies:
- Medicare Advantage prescription drug plans
- Silver Sneakers or other gym memberships or fitness programs
- Transportation to and from medical appointments
- Recommendations for diet and nutrition
- Allowance to help with over-the-counter medications
- Healthy living seminars and classes
- Hearing, vision, and dental care
It is important to know that not all insurance companies or Medicare Advantage plans include any or all of these perks. Make sure that you carefully compare what is and is not included in your policy before signing up for a policy so that you can choose the best one for you.
It’s best to look into your resources and be as well-informed as possible before signing up for a policy. Check out these helpful resources for Medicare beneficiaries/enrollees for more information, whether you live in Minnesota, New York, Massachusetts, Connecticut, or anywhere else in the United States:
- CMS: Centers for Medicare and Medicaid Services – This is a useful service if you want to learn more about the Medicare program or if you are dual-eligible for Medicare and Medicaid.
- Henry J. Kaiser Family Foundation – This site offers useful information about Medicare, Medicare Supplement insurance, Medicare Advantage, and other topics of interest.
- SSA – This is the official site for the Social Security Administration.
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