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Original Medicare is supplemented by Medicare Advantage, a bundled option. Private insurers that have a contract with the federal government to provide health insurance to those who qualify for Medicare provide Medicare Advantage plans.
Approximately four out of every ten persons eligible for Medicare are enrolled in a Medicare Advantage plan.
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The pros and cons of Medicare Advantage
Medicare Advantage plans include both benefits and drawbacks. While they may seem obvious to some, they are not appropriate for everyone.
- There may be other benefits available, such as cost savings or subsidies for hearing, dental, and vision care.
- Premiums for insurance coverage may be decreased.
- Limits on how much you may have to spend out of pocket for hospital and medical services. This limit is decided by the Centers for Medicare & Medicaid Services, and it will be $7,550 in 2022.
- When it comes to medical services, you have fewer alternatives.
- You must live in the geographic coverage zone of the plan and obtain non-emergency medical treatment there.
- You won’t be able to switch back to Original Medicare if you have Medicare Supplement Insurance coverage.
- It’s possible that the insurer, or the network and its medical providers, will cancel the plan. (If this happens, you’ll be notified and offered further alternatives.)
How Medicare Advantage plans work
Medicare Advantage plans, often known as Medicare Part C, are required to cover the same services as Medicare Parts A and B, which cover hospitalization and doctor visits, respectively. Medicare Advantage plans frequently include non-Medicare services such as basic dental care, eye exams and glasses, and hearing aids, which can save you money.
Medicare Advantage vs. Original Medicare
Medicare Advantage schemes’ provider networks may limit your alternatives. If you go outside the network, your care may not be covered, or it may cost substantially more than if you stay in the network. If you have Original Medicare, you can see any doctor or go to any medical facility that takes Medicare assignments.
In exchange for reduced freedom, you usually spend less. Although you’d still have to pay a monthly Part B premium, a Medicare Advantage plan may be less expensive than a Medigap plan. There are times when there is no premium for the Medicare Advantage plan.
Medicare Advantage plans may also have a maximum out-of-pocket limit for covered services. This limits the amount of money you’ll have to pay on top of your premiums. In 2022, the upper limit will be $7,550.
Medicare Advantage vs. Medigap
Medicare Advantage plans and Medicare Supplement Insurance, or Medigap, are commonly misunderstood. Both are available from private insurance companies, but the way your expenses are reimbursed differs. Medigap plans, as the name suggests, fill in the “gaps” in Original Medicare by paying your share of covered expenses (typically 20%). When you seek medical treatment, your Medigap coverage will cover most or all of your copayments. For this, you’ll have to pay a monthly cost.
Medicare Advantage plans, on the other hand, are bundled plans that provide coverage similar to Medicare Parts A and B (and, in most circumstances, Part D), as well as limited coverage for dental procedures and over-the-counter medications. A fee may be charged for a Medicare Advantage plan, although many are provided free of charge in addition to your necessary Medicare Part B payment. You’ll have to pay copays or coinsurance when you see the doctor. If you have a Medicare Advantage plan, you’ll have to pay out of pocket whenever you see a provider, and the out-of-pocket limit for qualified treatment in 2022 is $7,550.
Because Medigap insurance is standardized, it’s also rather simple to compare prices. Comparing Medicare Advantage plans might be difficult since each one is different. It is not possible to obtain both a Medicare Advantage plan and a Medigap policy at the same time.
How to choose the best Medicare Advantage plan
Consider your health care requirements and what each type of plan has to offer when evaluating Medicare Advantage plans. You’ll need health insurance that they accept if you have a chronic condition and wish to continue visiting the same doctor or facility. If you use prescription medications, certain plans may have lower out-of-pocket costs than others.
While comparing Medicare Advantage plans, keep the following questions in mind:
- Is it necessary to have a referral to see a specialist?
- What are the pros and disadvantages of each plan? (Do you need a vision or dental treatment, and if so, is it covered?)
- Is your prescription drug coverage all-inclusive, and how much will it cost?
- Do you have health insurance that covers your doctors?
- What is the plan’s Medicare star rating?
Medicare Advantage providers
Below is further information on some of the most popular Medicare Advantage plans. These insurers provide coverage in most states. Your ZIP code and county will decide which options are accessible to you.
Read the “Welcome to Medicare” booklet if you’ve applied for Medicare.
How to enroll in a Medicare Advantage plan
When you’ve done your research and found a Medicare Advantage plan that matches your needs, you may enroll in one of many ways:
- Use Medicare’s plan finder to find a plan in your area. From the drop-down option, choose “Enroll.”
- Go to the plan’s website to see whether you can enroll online. Contact the plan for a printed enrollment form. Complete it and return it to the insurance company.
- Make a call to the provider of the plan you’d like to join.
- To talk with a Medicare representative, dial 1-800-MEDICARE (800-633-4227).
You’ll need your Medicare number and the start date of your Medicare Part A and/or Part B coverage. You must be enrolled in Medicare Parts A and B before purchasing a Medicare Advantage plan.
Remember that you may only enroll in a Medicare Advantage plan during your Initial Enrollment Period (when you initially become eligible for Medicare) or the Open Enrollment Period (October 15 to December 7). During Medicare Advantage Open Enrollment, which runs from January 1 to March 31 each year, you can switch Medicare Advantage plans.
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How to switch Medicare Advantage plans
You can transfer Medicare Advantage plans once a year, either during the Medicare open enrollment period (October 15 to December 7) or the Medicare Advantage open enrollment period (January 1 to March 31). (January 1 to March 31). (From January 1 to March 31)
During these times, you can also switch to Original Medicare, however moving after the first year may make it harder to get Medicare Supplemental Insurance. Most states only require insurers to provide Medigap coverage during your initial Medigap enrollment period (typically six months after your 65th birthday and enrollment in Medicare Part B) or if you leave your Medicare Advantage plan within the first year. Insurers may deny you Medigap coverage or impose a waiting period before your prior diseases are covered if you have health problems after that.
Frequently asked questions
Who can enroll in a Medicare Advantage plan?
You can enroll in a Medicare Advantage plan if you already have Medicare Parts A and B and the plan is offered in your area.
What is the difference between Medicare and Medicare Advantage?
Original Medicare includes Parts A and B (hospital and medical insurance) (medical insurance). If you want prescription coverage, you’ll also need to sign up for Medicare Part D. You can buy Medicare Supplemental Insurance (Medigap) to help cover your out-of-pocket costs, and you can go to any Medicare-accepting health care provider in the US.
Medicare Advantage is a bundled plan that includes Parts A, B, and, in certain situations, D of Medicare. Out-of-pocket costs are likely to be lower, and most plans offer discounts or subsidies for eye and dental treatment. You can only see doctors who are part of the plan’s network if you have a Medicare Advantage plan.
Do most Medicare Advantage plans offer prescription drug coverage?
Most Medicare Advantage plans provide prescription medication coverage (but not all). If you require prescription drug coverage, check to see if it is covered in the plan you are considering.
Do all doctors accept Medicare Advantage?
Medicare Advantage is not accepted by all physicians. In most cases, you must seek medical treatment from physicians in your Medicare Advantage plan’s network. Some plans let you use out-of-network providers only in an emergency, while others allow you to use them anytime you want for a higher out-of-pocket cost.