Medicare Advantage Plans - A Discussion

Medicare Advantage Plans

Medicare plans and options can be among some of the most confusing choices for seniors to make. The overwhelming information regarding Medicare is often convoluted, causing confusion among seniors as well as other family members on the best choices to make for their present and future care. Understanding a little bit about Advantage Plans may help clear the waters and help you make wiser decisions when it comes to your health care options on a yearly basis.

Medicare Advantage Plans - The Basics

Seniors have two options when it comes to signing up for Medicare services when they turn 65. You can either sign up for original Medicare or sign up for a Medicare Advantage plan.

An Advantage plan is also called Medicare Part C. This plan includes both Part A, which offers hospitalization insurance, and Part B, which includes medical insurance. An Advantage plan is designed much like an HMO (health maintenance organization) or PPO, (preferred provider organization). Many private health insurance companies and carriers approve and provide Medicare Advantage plans.

Medicare Advantage Plans

When choosing an Advantage plan, you need to visit the doctors, medical providers, hospitals and other facilities that are provided within the plan or you'll pay more, and in some cases, all of your health care costs. This means that you choose your primary care provider from a list offered by the Medicare Advantage plan in your state.

Advantage plans also carries a monthly premium in addition to regular Medicare Part B premiums. You may also need to pay co-insurance and co-payments for covered services under both. Advantage plans differ by state and offer different levels of included or extra coverage services as well as regulations and eligibility.

If you choose an Advantage plan, you'll also need to decide whether you want to sign up for Medicare Part D or prescription drug coverage. In most cases, prescription drug coverage is offered in a Medicare Plan, but if it isn't, you can choose from a number of Medicare prescription drug plans separately.

One of the greatest benefits of an Advantage plan is that they often offer extra coverage for hearing, vision and dental services. Some may include health and wellness programs as well as preventive care.

Another benefit of joining a Advantage plan is that you won't need a Medicare gap policy. Medicare gap policies are very popular in helping to pay for out-of-pocket expenses and costs. Individuals with limited income and resources may benefit from a Medicare plan that can be combined with other types of health insurance coverage provided by the military, Veteran's benefits, employers or unions.

Medicare Advantage Plans

Paying For a Medicare Advantage Plans

Choices and prices for Medicare Advantage (Part C) plans differ by state. Medicare pays companies that offer Advantage plans a certain amount for your care on a monthly basis.

Consumers need to research their out-of-pocket costs as well as rules and eligibility for accessing services under Advantage plan, as some may require that you receive a referral by your primary care provider before you can see a specialist.

Costs for the Advantage plan are determined by a number of variables including:

  • The amount of co-payment or co-insurance for visits and services to your primary care provider
  • Whether your plan has a yearly deductible
  • Whether your plan pays any of your monthly Part B premiums
  • Whether your plan charges a monthly premium
  • The type of services that you may need as well as the frequency of your doctor's visits and needs
  • Yearly limits on out-of-pocket expenses

Advantage Plans - Coverage

Urgent care and emergency care is always covered under an Advantage plan. Advantage plans must also, by law, cover all of the types of services offered under original Medicare, though this does not include hospice care. Seniors should not consider Advantage plans as a supplemental form of coverage, but as a different type of Medicare plan that offers the basics of original Medicare coverage plus a few extras. Determine what's available in your area, as plan rules, services and costs will differ.

Medicare and Medicaid Page


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