There are roughly 18 million people out of 56 million enrolled in a Medicare Advantage Insurance Plan. This has become an increasingly popular option, as Medicare Advantage Insurance Plans, or Medicare Part C, offer the same services as Original Medicare Part A and Part B. However, when you opt for an alternative to Original Medicare Part A & Part B, it doesn’t mean you give up services or rights that come with Original Medicare. With the exception of hospice care, Medicare Advantage Insurance Plans are actually required to offer the same services you receive through Original Medicare Part A & Part B. So what is different with Medicare Advantage Insurance Plans? Here is what you need to know about Medicare Advantage Insurance Plans:
You Have More Coverage Options
The most attractive part of Medicare Advantage Insurance Plans is the amount of choice you have as the consumer. Medicare Advantage Insure Plans are offered by private insurance companies, meaning they tend to contain all components of Medicare in one package. If you are only enrolled in Original Medicare Part A & Part B, you may have to enroll into each of those components separately, as well as Medicare Part D Prescription Drug Plans. However, with Medicare Advantage Insurance Plans, most contain A, B, and D together. Medicare Advantage Insurance Plans typically cover basic vision, hearing and/or dental exams, which cannot be purchased through Original Medicare–but commonly an insurance agent selling what is known as “DVH” or “supplemental products”.
You Will Need Referrals to See a Specialist
Many Medicare Advantage Insurance Plans require a referral to see a specialist. Because your plan is covered by a private insurer and not through the government, health-benefit providers are be a bit picky about which doctors you see and which services will be covered. In other words, there could be more steps involved if you are in need of seeing a specialist for medical care.
Original Medicare Part A & Part B is a massive government-sponsored plan and is accepted by over 90% of hospitals and physicians around the county. However, Medicare Advantage Insurance Plans are contracted with a smaller handful of hospitals and physicians, meanings that your medical care choices are more narrow. Because your plan is offered by a private insurer, both the price and the approved physicians within the network can change annually.
Annual Out-of-Pocket Limits
One of the “advantages” of a Medicare Advantage Insurance Plan is the annual out-of-pocket limits. Under Original Medicare Part A & Part B, there are no limits on how much of your own money you can pay for medical care. Typically, Original Medicare Part A & Part B covers 80% of your medical expenses, with the remainder falling on your shoulders. If you happen to undergo treatment with any new cancer drug, you could be looking at an annual out-of-pocket cost of more than $20,000. That’s where a Medicare Advantage Insurance Plan could truly be ideal for you. In 2016, Medicare Advantage Insurance Plans have annual out-of-pocket limits of $6,700. This means Medicare Beneficiaries who decide to purchase a Medicare Advantage Insurance Plan may have a better idea of how much their medical care will cost.
However, there are no guarantees that your out-of-pocket payments leading up to that $6,700 won’t be higher under a Medicare Advantage Insurance Plan. For instance, certain services could require a higher copay and if you have to go out of network for care, then your out-of-pocket costs would be higher than they would be if you were enrolled in Original Medicare Part A & Part B.
It’s almost important to remember that the prescription drug costs don’t count towards your annual out-of-pocket limit.
Limited Enrollment Period
There’s an enrollment period each year between October 15 and December 7. This is reserved for Medicare Beneficiaries to enroll in Medicare Advantage Insurance plans or in parts of Original Medicare Part A & Part B. There is a separate period between January 1 and February 14 each year that allows Medicare Beneficiaries to disenroll from a Medicare Advantage Insurance Plan and enroll into Original Medicare Part A & Part B, but this is a one-way street and does not allow consumers to disenroll from Medicare in favor of a Medicare Advantage Insurance Plans. If you are interested in a Medicare Part C, or Medicare Advantage Insurance Plan, you must wait to enroll during the Annual Enrollment Period (AEP), October 15 and December 7.
If you are still wondering if Medicare Advantage Insurance Plans are right for you, contact one of our licensed insurance agents to learn more about plans available in your area.