If you are getting ready to sign up for Medicare insurance and are in the process of deciding whether to enroll in Original Medicare or a Medicare Advantage plan, it’s normal to feel a bit confused. Both options offer great Medicare coverage, and both have advantages and disadvantages.
Original Medicare includes Part A which is hospital insurance and Part B which is medical insurance. If you wish to have prescription drug coverage, you must enroll in a separate plan known as Medicare Part D.
A Medicare Advantage plan, or Medicare Part C, is a plan that private insurance companies sell to those who are eligible for Medicare coverage and already enrolled in Original Medicare Parts A and B. Medicare Advantage plans take the place of Original Medicare insurance, offering the same coverage as both Parts A and B but many include extra benefits. Part C plans generally provide more comprehensive health care coverage, but most plans require that enrollees use a specific network of health care providers and suppliers.
Today, there are over 24 million Medicare beneficiaries enrolled in Medicare Advantage and the average beneficiary has access to more than 30 different Part C plans. If you have been wondering if this private alternative to traditional Medicare is right for you, here are five reasons to choose a Medicare Advantage plan.
According to laws in the United States, all Medicare Advantage plans are required to provide the same benefits as Original Medicare Parts A and B – at least. Most Part C plans also provide extra benefits such as hearing, vision, and dental care services, and/or memberships to fitness programs like Silver Sneakers. Most Medicare Advantage plans also include prescription drug coverage as part of the plan package. Part C plans generally provide more comprehensive health care coverage and protect beneficiaries in cases of unexpected illnesses or injuries.
Medicare Part C insurance plans are sold by private insurance providers across the country. All Medicare Advantage plans bundle your benefits into one plan which includes hospital, medical care, extra benefits, and prescription drug coverage, if applicable.
Many insurance providers offer several plan options to choose from, so you can get one that fits your health care needs. The different types of plans you can choose from include:
• Health Maintenance Organization (HMO) plans use health care providers and suppliers that are within the plan’s network. HMOs also require referrals for visits to specialists.
• Preferred Provider Organization (PPO) plans have different charges for using health care providers and suppliers within their network and outside their network.
• Private Fee-for-Service (PFFS) plans offer more flexibility for beneficiaries but with special payment requirements.
• Special Needs (SNP) plans assist beneficiaries with long-term medical costs when chronic conditions are involved.
• Medical Savings Account (MSA) plans join together with high-deductible health plans for coverage.
3. Emergency care
Even if your plan requires that you use health care providers and suppliers that are within your plan’s network, Medicare Advantage plans must provide coverage for any emergency or urgent care you need anywhere in the United States.
All Medicare Advantage plans have an annual out-of-pocket maximum. When you reach the limit, your plan takes over and provides 100 percent of your coverage. Many Part C plans have a $0 monthly premium and in some cases, your plan may also cover all, or a portion, of your Medicare Part B monthly premium.
Depending on the plan you enroll in, you may have deductibles, copayments, coinsurance, or extra charges for using providers outside the plan’s network. Make sure you examine the plan’s details before signing up.
5. Coordinated care
If you get your health care through Medicare Part C coverage, you may have the option to get coordinated medical care. Using coordinated care, your health care providers communicate with each other to provide you with the proper care for your needs. This also helps avoid extra expenses and wasted time.
Do I Need a Referral to See a Specialist with Medicare Advantage Plans?(Opens in a new browser tab)
Understanding How Medicare Advantage Works(Opens in a new browser tab)