Unlike Medicare (sponsored by the federal government), Medicare Advantage plans are offered by private health insurance companies. Advantage plans have become popular these days because of their lower premiums and additional benefits that are not provided by original Medicare. However, these plans also have some cons and can cost more in the long run. To choose between the two, you must know how Medicare Advantage plans work compared to Medicare and what are its benefits and demerits. Let us discuss all of them.
Medicare Advantage Plans Provide Multiple Healthcare Services
Medicare Advantage, also known as Medicare Part C, covers all benefits included in Part A, Part B, and Part D and provides additional services, such as dental coverage, hearing coverage, vision coverage, and fitness club membership. You must have Medicare Part A (covers hospitals) and Part B (covers doctor visits) coverages to enroll in a Medicare Advantage plan, which means you have to pay premiums for both Part B and advantage plan, while Part A is usually free.
Social security beneficiaries over 65 years will be automatically enrolled in a Medicare plan. Those who are not receiving Social Security benefits or don’t have private health insurance or employer-sponsored health plan must enroll in Part A and Part B when they turn 65. Otherwise, late penalties may apply. Advantage plans and Medicare Supplemental insurance (Medigap) are not mandatory.
Another benefit of advantage plans is they have no medical underwriting at all. If you don’t enroll in the Medicare Advantage plan before or after you turn 65, you can do it during the general enrollment period, which runs from January 1 to March 31 annually, with coverage beginning on July 1st of your enrollment year.
Demerits of Medicare Advantages Plans
Out-of-pocket costs are higher for the Medicare Advantage plan compared to original Medicare when combined with a Medigap (which has no out-of-pocket maximums). Also, Medicare Advantage plans’ cost-sharing requirements (such as coinsurance for drugs and copays for hospital stays) are a major drawback.
Medicare Advantage plans require referrals for specialists, and you need to pay more for an out-of-network doctor or hospital. However, original Medicare accepts every doctor or hospital.
You can switch from an Advantage plan to Medigap and original Medicare, but you may be underinsured temporarily. Medigap plans do not require medical underwriting, only for the six months after you enroll in Part B. At other times, such as after having Advantage plans, your provider may charge more or impose a waiting period.
How to Buy a Medicare Advantage Plan?
You can enroll in a Medicare Advantage plan either online or in person at your insurance office. However, before that, you must:
- Visit the official website of Medicare to know the estimated copays, premiums, and out-of-pocket expenses of advantage plans and other Medicare coverages.
- Check your provider’s website to check whether your preferred doctors are in the network for advantage plans you consider.
- You can contact Medicare’s 24-hour live chat if you have any questions concerning the coverage.
These things will help you choose the right Medicare Advantage plan for your medical needs.
Compare the overall expenses of the original Medicare and Medicare Advantage plan and then choose the one that remains affordable while offering extensive coverage.