Four things you need to know about Medicare advantage plans
When you approach 65, you will find many offers for Medicare advantage plans in your mailbox. However, the variety of available plans can be confusing, and understanding the differences may save you money.
Medicare Advantage plans are an excellent option to improve your health care benefits when on Medicare. Almost 50% percent of all Medicare beneficiaries are currently enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation. Nationwide, there are over plenty of plans offered, however, depending on your local area, you may find only a handful available to you.
While many seniors may assume that their medical insurance is taken care of when they turn 65 and are eligible for Medicare, the fact is that Medicare only pays for basic medical care, and does not cover the total amount of charges incurred for your health-related services. In addition to that, original Medicare does not offer coverage for various healthcare services such as dental, hearing or vision.
1. What is covered by Medicare advantage plans?
Advantage policies, offered by Medicare-approved private insurance companies, offer the same benefits and many times much more than what is covered by your traditional Part A and Part B. This means, most plans provide coverage for inpatient care, outpatient care and in many cases, prescription drug coverage. More and more even include fitness benefits, such as the very popular SilverSneaker program by Healthways*.
If you opt for an advantage plan policy that includes prescription drug coverage (a so called MA-PD), you will not need to get an additional plan. However, your current medication or pharmacy might not be included. So you need to compare your list of medicine with the plan’s ‘formulary’ and list of providers.
2. How do Medicare advantage plans work?
In a typical advantage plan, the insurer has built a large network of health care facilities and providers for the beneficiary to use. Most Medicare advantage plans are either HMO (Medicare Health Maintenance Organizations) or Preferred Provider Organizations (PPO), while some are Private Fee For Service Plans and Medicare Special Needs Plan.
HMO (Medicare Health Maintenance Organizations) and Preferred Provider Organizations (PPO) are around for a long time when it comes to health insurance. Both utilize networks of providers, and as long as you use them, you will find that your co-payments are very affordable. This is one of the reasons why Medicare advantage plans are typically a very popular choice. A few insurance providers offer PFFS (Private Fee For Service Plans), that will let you go to whichever health care professional you choose, however you will have a higher co-payment.
To be certain that you will get the healthcare you need, examine the plan’s network list of medical providers, as well as the prescription medication the plan will pay for, before you sign up. If your preferred doctor or hospital is not included in the network, you will either have to change your provider or the plan, as almost all (except the FFS plans) don’t insure health care services taken from outside their network.
3. Which Medicare advantage plan is best for me?
Medicare advantage plans are rated by the CMS, a governmental agency, on a five-star scale. These ratings make it easy to compare plans, based on quality and performance. A higher ranking means considerably more federal financing for the insurance provider, which helps keeping the insurance premiums for the members moderate, and favoring a 5-star plan is usually a good choice for the consumer.
However, the monthly premium and the benefits for medical services are the most important factors when it comes to selecting the best MAP for your individual medical needs. Having 5 stars doesn’t mean a plan will cover the prescription drugs you need to take, or that your doctor will accept it!
4. How and when can I enroll in a Medicare advantage plan?
You may enroll in an advantage plan when you first become eligible for Medicare. Once you missed enrolling during this initial enrollment period, you can only join a Medicare Advantage Plan during the annual open enrollment period between October 15 and December 7 of every year. If you realize you would switch back to original Medicare, it is possible to transition back in between January 1 and February 14 of each year. There is an exception, though: You can join or switch to a 5-star Medicare plan at any time, once a year.
Follow the link to find Medicare advantage plans that are available in your area, by using the Medicare plan finder tool on the official Medicare.gov website.
This is not a solicitation or recommendation of insurance. This website is not affiliated with or endorsed by SilverSneakers. SilverSneakers is a product of Healthways, the leading provider of specialized, comprehensive Health and Care SupportSM solutions and a partner in the Gallup-Healthways Well-Being Health Index. You can find more information at https://www.silversneakers.com/.
