The world of health care insurance can be confusing, especially for Americans. We often think of retirement age and Medicare, but as we've previously covered about the world of Medicare here, the federal health insurance program comes in many variations, and Medicare Advantage is one of them.
While all these plans are created to support the elderly and disabled individuals, the main difference is that private insurance companies actually provide Medicare Advantage. It is also a bundle deal that includes Medicare Part A's hospital coverage, Part B's medical coverage, and sometimes even Part D's drug coverage.
Enrolling in a Medicare Advantage Plan can be a cost-effective way of securing your health for the future. However, even Medicare Advantage Plans are not equal in terms of benefits, services, and costs. Before you make the daunting financial decision of choosing a health care plan, here are several important factors to consider.
There are many kinds of Medical Advantage Plans, the most common being Health Maintenance Organization (HMO) Plans and Preferred Provider Organization (PPO) Plans.
When you are enrolled in an HMO plan, your coverage is limited to the health care providers within the plan's network. You will have to pay additional costs to see out-of-network providers. In addition, HMO plans will require you to choose a Primary Care Physician (PCP). To see a specialist, you are required to obtain a referral from your PCP.
PPO Plans also encourage you to use health care providers within their network, but unlike HMO plans, you are given more out-of-network coverage. You also won't be required to get referrals should you ever need to see a specialist. PPO plans are generally better for those who want more flexibility.
Choice of Health Care Providers
Whether you choose an HMO or a PPO, getting the most out of your Medicare Advantage Plan means limiting yourself to the health care providers within their network. Therefore, when choosing a plan, it's important to see whether their network is fully capable of addressing your specific healthcare needs. A senior with a history of heart problems, for example, will want to look at a plan that has many skilled cardiologists available within the network.
Should the restrictive nature of a network-exclusive coverage pose a problem, you might want to look at plans with larger networks. A company like Anthem, which started in California and now has 784,000 provider locations, should be sufficient for seniors who require several different specialists.
It is essential to consider your location as well. It's better to choose a Medicare Advantage Plan with in-network doctors, hospitals, and pharmacies that are close to your home.
Coverage and Benefits
Medicare Advantage Plans can also cover health care costs that are usually unavailable with traditional Medicare. Health care company Kaiser Permanente even includes acupuncture and chiropractic services for seniors based in Hawaii.
Meanwhile, Kelsey Care provides Medicare plans in Houston that include vision, dental, and even fitness expenses that this type of health insurance can cover. These extra benefits can be useful for seniors who want to reduce their out-of-pocket spending. This can be anything from a pair of eyeglasses or access to gym memberships that can keep them healthy and improve their quality of life.
You will also want to consider whether your plan offers remote services. Plans that include telehealth and mail delivery for prescriptions can be useful for those who want to keep safe, or even just those who want to access healthcare options from the convenience of their home.
Additionally, most Medicare Advantage Plans include Part D, Medicare's drug-focused plan. Selecting a plan that includes drug coverage can help you cut down expenses on costly prescriptions.
No Premium with Medicare Advantage?
Most Medicare Advantage Plans charge no premium. A few have very small premiums. However, when you enroll in a Medicare Advantage Plan, you are still required to pay the standard Medicare Part B monthly premium, which in 2021 is $148.50. Multinational companies Cigna and Aetna offer Part B premium reduction plans, but these are limited to certain areas.
In addition, Medicare Advantage charges you a co-payment flat fee for doctor and specialist visits. Co-payment costs are decided by your plan provider and usually depend on your plan type, benefits, and location.
Unlike traditional Medicare, Medicare Advantage has a fixed maximum out-of-pocket limit to protect you from high medical costs. In 2021, the Medicare Drug and Health Plan Contract Administration Group set the limit to $7,550.
Long-Term Care and Medicare Products
About half of those aged 65 and over will need long-term care services and supports during their lifetime. These costs can be very expensive depending on the type of service and where you live Cost of Care Calculator - Choose Your State | LTC News.
Generally, Medicare, traditional supplements, and Medicare Advantage plans pay a very limited amount for long-term health care. These plans will pay 100 days of skilled services, including rehabilitative care.
Some Medicare Advantage plans will pay a limited amount of adult day care, nutrition services, and some home modifications. However, most long-term care is custodial care - help with daily activities or supervision due to cognitive decline - and any Medicare product does not cover that.
Medicaid will pay for long-term care services and supports, but you must have little or no assets to qualify. Long-Term Care Insurance will provide benefits for all types of long-term health care, but you must purchase coverage separately, ideally before retirement - Doesn't Health Insurance Pay for Long-Term Care? What About Medicare and Supplements? Medicaid? | LTC News.
Protecting your health doesn't have to be expensive. With a Medicare Advantage Plan, you can secure hospital coverage, medical coverage, and even drug coverage, all in a single bundle.
If you want a Medicare Advantage Plan you can make the most out of, you must do your due diligence. Learning about the different benefits offered by various health care plans will help you secure a comfortable and healthy life in your senior years.
About the Author
Jena Bessey is a long-time writer, short-time freelancer. After quitting her desk job to pursue opportunities on her own, she's found that in the solace of working in her own home, she gets more done. It's a plus that she gets to bask in the presence of her 2 beloved dogs, and 3 cats who she shares a passionate love-hate relationship with.
Contributor since December 3rd, 2019
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