The decisions you make about a Medicare health plan will affect not only the services you get and quality of your care but how much you pay and the doctors you can use. Before you are able to understand the advantages you can gain from a Medicare Advantage Plan, you need to know more details.
What is a Medicare Advantage Plan?
Medicare Advantage is an alternative to Original Medicare offered by Medicare-approved private companies. These companies are required to follow Medicare rules. If you join a Medicare Advantage Plan, you will still have Medicare but most of your coverage will come from your Medicare Advantage Plan.
A number of different types of Medicare Advantage Plans are available and you need to find out which ones are available in your area. Visit Medicare Advantage Plans 2021 to learn more and compare different plans so you understand all the options available to you.
How does a Medicare Advantage Plan work?
The company offering you the Medicare Advantage Plan receives a fixed amount from Medicare for your coverage every month. Medicare Advantage Plans have a yearly contract with Medicare and must notify you about any changes before the beginning of a new enrollment year.
In most cases, you have to use doctors in a specific network. You may need to get a referral to see a specialist. In some cases, you need approval before the time for a service or supply if you want coverage by the plan.
Medicare Advantage plans are required to cover all Medicare Part A and B services. In addition, they may offer certain benefits not covered by Original Medicare, such as vision, hearing and dental care. Most of them cover prescription medication too.
You are always covered for emergency and urgent care. Original Medicare will still cover some costs, such as hospice care.
Plans have a year limit on what you will pay out-of-pocket for services covered by Part A and Part B. Once you reach the limit, you pay nothing for Part A and Part B covered services for the remainder of the year.
What about the cost?
Every year the plan sets the amount it charges for premiums, services and deductibles. What you pay only changes once a year, on January 1. Companies usually charge a premium in addition to the Part B premium you have to pay.
Deductibles are the amounts you pay for health care or prescriptions before other insurances begin to pay. Coinsurance is the amount you may be required to pay as your share of the cost of services after you pay any deductibles. Copayment is the amount you may be required to pay as your share for the cost of a medical service or supply, such as a doctor’s visit.
Medigap policies don’t work with Medicare Advantage plans and you can’t use them to pay deductibles, coinsurance or copayments.
Some of the main benefits of a Medicare Advantage plan
- All your coverage options are available in one convenient plan.
- There are many different plan types, offering you the opportunity to choose the type that best suits your personal situation.
- Your plan may offer lower out-of-pocket expenses than Original Medicare. In exchange for lower cost-sharing, you may have to settle for less choice of doctors or hospitals.
- Any providers you visit are part of a network and can provide you with coordinated, effective medical care.
The best Medicare plan for your needs will offer you the coverage you need at a cost you can afford. The best ones will offer you flexibility, quality care and long-term cost savings.