Making Sense Of Medicare Advantage

If you’ve been working all your life, you deserve coverage when you need it. Although Original Medicare is certainly helpful, it often fails to cover many expenses. You may still be burdened with copayments, deductibles, coinsurance, and other expenses. To help with these costs, you can get Medicare Advantage.

What Is Medicare Advantage?

Medicare Advantage Plans are additional plans, also referred to as “Part C” or “MA Plans.” These plans are provided by private companies that Medicare has approved. Medicare also pays these companies to cover your benefits.
Medicare Advantage is important for one primary reason. It handles all of your hospital and medical insurance for Medicare Part A and Part B.

What Is Covered Under Medicare Advantage?

Medicare Advantage Plans cover everything Original Medicare does. However, hospice care is the exception. That said, Original Medicare will still cover hospice care, even if you’ve joined a Medicare Advantage Plan.
Medicare Advantage Plans also cover emergency and urgent care, even if you require such care outside the plan’s service area. Emergencies outside the U.S., however, may not be covered by Medicare Advantage. Some Medicare Advantage Plans will even provide benefits for things such as eye-wear, dental care, and/or health & wellness programs.
The majority of Medicare Advantage Plans also include Part D, Medicare prescription drug coverage.

How Do I Qualify?

In order to qualify for Medicare Advantage, you must have Medicare Parts A and B. You must also live in an area where the plan is serviced. Unfortunately, individuals with End-Stage Renal Disease usually cannot receive a Medicare Advantage Plan.

What Plans Can I Get Under Medicare Advantage?

Medicare Advantage Plans come in a number of types. Each type provides different networks, terms and conditions. These aspects may greatly impact the services you can receive.
Preferred Provider Organization (PPO) plans: These plans incentivize doctors, health care providers and hospitals within the network. Your costs will be lower if you choose such providers.
Health Maintenance Organization (HMO) plans: These plans allow you to visit certain doctors, health care providers, and hospitals, as long as they’re within a given network. Many primary physicians may have to provide referrals if you need to see specialized doctors. Medical emergencies are exceptions.
Special Needs Plans (SNPs): These plans work best for certain populations that require certain types of specialized health care. Such populations include nursing home residents, people with chronic conditions, and people using both Medicare and Medicaid.
Medical Savings Account (MSA) plans: These plans require a high-deductible and a bank account. Medicare then deposits funds into your account (typically below deductible). This money is accessible for health care services throughout the year. However, Medicare drug coverage is not provided. To receive drug coverage, you must join a Medicare Prescription Drug Plan.
Private Fee-for-Service (PFFS) plans: These plans mirror Original Medicare. Typically, PFFS plans allow you to visit any provider or medical facility, if the plan’s payment terms are accepted. These plans differentiate payments based on the various types of doctors and providers. Required payments are made explicit.
HMO Point-of-Service (HMOPOS) plans: These plans are modified HMO plans. Such plans permit you to receive certain out-of-network services, given a higher copayment or coinsurance.

How Much Do I Pay For Medicare Advantage?

You will have both a Part B premium and a single monthly premium for your Medicare Advantage services. However, every plan differs. Some Medicare Advantage plans may have significantly higher premiums and costs, given the services and benefits provided.