If you’re nearing your Medicare enrollment age, perhaps you have heard of Medicare Advantage plans. Medicare Advantage plans are sold by private insurance companies and offer an alternative way to get your Original Medicare coverage. These policies can be a great way for certain people to receive their Medicare coverage while, in some cases, actually saving money and enjoying additional benefits.
Medicare Advantage is also known as Medicare Part C. These plans must offer benefits that are at least equal to the coverage offered by Original Medicare (with the exception of hospice care). This means coverage for inpatient care (Part A) and outpatient care (Part B).
Aside from inpatient hospital care, Medicare Part A hospital insurance helps to pay for things like Skilled Nursing Facility (SNF) care and some home health care. Medicare Part B medical insurance helps to cover the costs of doctor’s visits, durable medical equipment, some preventative care, and more.
When you have Original Medicare (Parts A & B) and enroll in a Medicare Advantage plan, the Medicare Advantage plan then becomes your primary coverage. Most Medicare Advantage plans also come with some sort of additional benefits. Read on to find out what else your Medicare Advantage plan could cover beyond what is covered by Original Medicare.
What additional benefits can Medicare Advantage plans offer?
Medicare Advantage plans can offer coverage beyond what Original Medicare offers. These plans may also cover things that Original Medicare doesn’t pay for, like vision, hearing, and dental coverage. Medicare Advantage plans can even cover wellness or fitness programs, such as gym memberships. Some plans may also cover the cost of things like transportation for trips to the doctor and adult day-care services. Plus, many Medicare Advantage plans offer prescription drug coverage, something that you can’t get through Original Medicare coverage alone.
There are certain MA plans (SNPs) that are designed specifically for beneficiaries who qualify for Medicare because they suffer from some sort of disability or chronic condition. These Medicare Advantage plans work well for individuals who have to cover medical expenses related to their chronic condition, as the services covered under these plans are specific to the conditions from which their beneficiaries suffer.
While Medicare Advantage plans must offer all the benefits covered by Original Medicare (Part A and Part B), they are not legally required to offer all or any of the extra benefits that we mentioned above. For that reason, it is a good idea to check with the insurance company (or insurance agent) that you plan on purchasing a plan through to find out what extra benefits any given plan offers.
Costs of Medicare Advantage Plans
To begin, some Medicare Advantage plans require you to pay a monthly premium. The good news is that many plans come with low or even $0 premiums. Remember, you will still have to pay your Part B monthly premium (which is set at $148.50 in 2021), though some MA policies may even help you to pay for some or all of your Part B premium.
Some plans also come with deductibles and copays/coinsurance. It is important to be aware of these factors when choosing a plan, as they can impact how much you have to pay for your medical costs each year.
The good news is that all Medicare Advantage plans come with an out-of-pocket maximum limit. These limits put a cap on your out-of-pocket costs and are one of the benefits of enrolling in a Medicare Advantage plan.
In 2021, the Medicare Advantage maximum out-of-pocket limit has been set at $7,550 (and $11,300 for in- and out-of-network combined). Insurance companies can also set lower out-of-pocket maximums. Be aware that this amount doesn’t include out-of-pocket costs related to prescription drugs.
Medicare Advantage Plan Networks
It is also important to be aware of whether any given plan operates with a network of providers. Certain types of Medicare Advantage plans, such as Health Maintenance Organization (HMO) plans, will only fully cover visits to health care providers that are within the plan’s network.
What this means is that you may very well face higher out-of-pocket expenses should you choose to visit an out-of-network provider. If you enroll in an HMO plan and want to visit a provider that is outside of your plan’s network, you may have to cover the full cost of their services out-of-pocket. Fortunately, Medicare Advantage policies have to offer emergency coverage nationwide, regardless of whether you are able to attend a facility within your plan’s network.
Medicare Advantage and Prescription Drug Coverage
Finally, it is important to be aware of whether any given Medicare Advantage plan offers drug coverage or not. Though many Medicare Advantage plans come with coverage for your prescription medications, not all do. And some Part C policies, such as Medicare Advantage HMO and PPO plans, prohibit you from enrolling in a separate prescription drug plan, even if the plan doesn’t offer coverage for your prescription drugs.
Other plans, like PFFS and MSA plans, allow you to enroll in a separate Part D plan if they don’t offer drug coverage. And all Medicare Advantage SNPs are required to provide prescription drug coverage.
As you can see, understanding the ins and outs of Medicare Advantage plans can be quite tricky. That’s why it is so important to know the right questions to ask when you are speaking with insurance companies about your Medicare options.
So how do you know what Medicare Advantage benefits you will get?
The specific coverage options offered by any given Medicare Advantage plan depend on which specific plan you choose. You should also be aware that plan availability varies by ZIP Code and county, so what plans you have available to you depends on where you reside.
For example, beneficiaries in Travis County, Texas can choose between 45 plans in 2021, while residents of smaller counties in Texas, like Sutton County and Terrel County, can choose from less than 10.
And in some states, Medicare Advantage plans are scarce (or not offered). In Wyoming and Alaska, for example, less than 5% of Medicare beneficiaries are enrolled in Medicare Advantage. Compare that with the national average of 42%.
Insurance companies must publish a Summary of Benefits for their Medicare Advantage plans. Your insurance agent will review the Summary of Benefits with you before you enroll in a plan. This will allow you to get a clear understanding of what benefits are and aren’t offered by any given Medicare Advantage policy.
If you are wondering if Medicare Part C is right for you, set up a call about Medicare options with the team at Medicare Plans Direct today. Please feel free to reach out, regardless of whether you are interested in Medicare Advantage plans, Medicare Supplement Insurance, or Medicare Part D prescription drug coverage. Our services are always free, and one of our experienced insurance agents can help you find the right Medicare coverage for you.