Medicare Advantage Plans Pros and Cons
Then you need to know Medicare Advantage plans work, what they cost and when and how to enroll. This article will summarize Medicare Advantage plans pros and cons. Then you can decide if a Medicare Advantage plan is right for you and you can look for the best plan for you.
How Medicare Advantage plans work
They are also known as Medicare Part C, Medicare Advantage plans, “all in one” plans, or managed care plans. They include the same Medicare A and B benefits as Original Medicare. Medicare A is hospital insurance and Medicare B covers doctors and outpatient services.
The plans are offered by private insurance companies who have a contract with Medicare to manage your benefits and pay your claims.
Many Medicare Advantage plans include Medicare Part D-prescription drug coverage, and extra benefits not covered by Medicare. These benefits are basic dental, vision, hearing and gym memberships.
These extra benefits are not include in Original Medicare and can save you money.
What Medicare Advantage plans cost
Most of the plans are HMOs or PPOs and some Medicare Advantage Plans have a “0” monthly premium. The plans have a set copay or coinsurance for most of the services. Preventive services are free.
There is also an Annual Maximum Out of Pocket, which is the most you can spend in a year. The Annual Maximum out of pocket includes what you pay for your medical costs, not your drug costs.
The differences between a Medicare Advantage HMO and a PPO
Medicare HMOs (Health Maintenance Organizations) require members to use providers from their contracted directory. You will be restricted to a local specified geographic area. Members can only receive coverage for out of network services in an emergency. You must select a Primary Care doctor who will manage your care and provide referrals to Specialists. Your costs for the services you use will be lower than in a Medicare PPO.
Medicare PPOs (Preferred Provider Organizations) cover a larger geographic area. In Florida, their are Regional PPOs which can be used around the state. The plans allow members to go in or out-of-network for covered services. Members don’t require referrals to see a specialist. The costs for services in a Medicare PPO are higher than in a Medicare HMO. In- network services have a lower cost than out-of-network services. Some plans allow you to use local networks when you travel out of state.
The Pros of Medicare advantage plans
Many of the plans have a “0” monthly premium. That means your only monthly cost if your Part B premium.
Unlike being in Original Medicare, the plans have an annual maximum out of pocket limit. That is the most you can spend on your health care costs in one year. Drug costs aren’t included.
The plans are easy to join as long as you have Medicare Part A and B and live in the plan’s service
There is only one medical question to answer- you have end stage kidney disease. If the answer is no, you will be accepted.
Most of the plans include drug coverage without an additional monthly premium.
Extra benefits, not covered by Original Medicare or a Medicare Supplement plan, are included. These are dental, vision, hearing and gym membership. The type of coverage for these benefits varies by plan.
The plans renew automatically during the following year, unless you cancel or change plans.
The Cons of Medicare advantage plans
- You have less freedom of choice selecting providers.
- In a Medicare HMO, you can not use out of network providers, except in an emergency.
- In a Medicare HMO, you usually need referrals to see specialists.
- A PPO allows you to go out of network, but at a higher cost.
- Your doctors may leave the network any time.
- Some plans have an annual maximum out of pocket of $6,700. If you have a lot of medical expenses, you could reach it.
- If you travel or live in another part of the United States, a managed care plan may not work for you.
Now that you know Medicare Advantage Plans pros and cons.
Which Medicare Advantage Plan is right for you
Now that you know the Pros and Cons of Medicare Advantage plans, which one should you enroll in? The right plan for one person might not be the right plan for another. That’s because the plans have their own drug list and vary in their copays for drugs on the list.
In order to find the right plan, you will need to review all the plans in your area. That way you can find the best plan for your drug and medical needs.
Remember, you’ll need to enroll in Medicare before you can enroll in a Medicare Advantage Plan.
I will help you select and enroll in the right Medicare Advantage Plan. If you want to review your plan during the Annual Enrollment Period, October 15-December 7.
For questions to ask about Original Medicare vs. Medicare Advantage, read this page.