If you are eligible for Medicare, you will have the choice of selecting from different types of coverage. Original Medicare is made up of Medicare Parts A and B, or you can select a Medicare Advantage plan which is offered through a private health insurance company. Medicare Advantage plans combine Part A and Part B benefits and may include Part D for prescription drugs. Having all of your coverage under one comprehensive plan may be beneficial for some people. To qualify for a Medicare Advantage plan, you must be enrolled in both Part A and Part B, and you will still be responsible for your Part B premiums. Medicare will pay the Advantage plan administrator a set amount each month to provide coverage and deliver your benefits. Additionally, you must live within the plan’s coverage area.
The Difference of Medicare Advantage
The main difference between Original Medicare and Medicare Advantage is the way in which you access your benefits. With Original Medicare, you can access care at any doctor’s office or hospital that accepts Medicare, and you are subject to deductibles and a 20 percent co-insurance on Part B. On the other hand, Medicare Advantage plans require you to access care through a network of providers in your coverage area and you will owe co-pays that vary depending on the services used. Additionally, Medicare Advantage plans tend to change more each year, but beneficiaries can review their plans each year to choose the one that best suits their needs for the upcoming coverage year.
The Advantage Of Medicare Advantage
The advantage of having a Medicare Advantage plan is that it provides a layer of financial protection in the event of a serious illness or other incident. This plan includes an out-of-pocket spending limit, so when beneficiaries reach that limit, their medical expenses are covered for the remainder of the year (except for Plan D expenses). Moreover, many Advantage plans also include Part D coverage for prescription drugs, so there is no need to purchase an additional plan. This was created to help those with Original Medicare who could not afford a Medigap plan.
The Decision of Medicare Advantage
Making the decision to choose a Medicare Advantage plan can be daunting, as there are so many options available. It’s important to remember that what works for someone else may not be the best choice for you, so it’s a very personal decision. To help you make the best decision, it’s best to speak with an insurance professional who can provide you with guidance and information about the different plans available. Before you start researching plans, ask yourself some important questions to help you identify your priorities: Do any of your preferred healthcare providers accept Medicare Advantage plans, or just Original Medicare? What types of insurance are accepted by your preferred hospital? Do you frequently travel outside of your coverage area, or spend significant time at a second home? How much risk are you willing to take on? Do you have a source of funding available in the event of large medical bills? How much peace of mind do you want to achieve? Do you need to know that your healthcare spending will remain stable, or are you okay with fluctuating expenses? Answering these questions can help you narrow down your choices and make a decision that best suits your needs.
HMOs
Health Maintenance Organizations (HMOs) come with the lowest premiums, but they offer less flexibility in terms of healthcare providers and out-of-pocket expenses may vary. To be part of an HMO, you must select an In-Network Primary Care Physician (PCP) who will coordinate your care and must be seen first for all healthcare needs, unless in an emergency. If a specialist is necessary, the PCP will refer you to an In-Network specialist. Preferred Provider Organizations (PPOs) offer more flexibility and out-of-network benefits. With PPOs, you do not need to select a primary care doctor and you can go directly to any doctor you choose. However, if the doctor is out of the network, it will usually cost more. PPOs can have higher premiums, so it’s recommended to have a broker help you find the best cost for your circumstances.
Selecting a Medicare plan necessitates careful research, time, and knowledge. You can see there are numerous elements that will lead you to your choice. The summaries above are just a general overview and are only meant to give you a basic outline of your possibilities. The most efficient way to find a Medicare policy that is right for you and your budget is to consult with a licensed insurance agent to investigate all available options and address any questions that are specific to your circumstances.