Open enrollment for Medicare Advantage plans began October 15. It will run through December 7, 2016. This is your opportunity to consider or reconsider your options regarding Medicare Advantage Plans, which are also commonly known as Medicare Part C. These plans are an alternative to Original Medicare, which includes Parts A and B, offered by private insurance carriers.
Generally, as long as you are enrolled in Medicare Parts A and B, you will be able to enroll in a Medicare Advantage Plan. However, those with End-Stage Renal Disease (which is also known as permanent kidney failure) likely will not be able to enroll in a Medicare Advantage Plan.
What is the Difference Between Original Medicare and Medicare Advantage?
Original Medicare covers general hospital care and some short stays in skilled nursing facilities under Part A. Part B covers expenses for outpatient services, including doctor’s visits, medical equipment, and other related expenses. Preventative services are also covered under Part B. Both parts of original Medicare are offered and substantially paid for by the government. You likely will have to pay a premium for Part B, however.
Part C, or Medicare Advantage Plans, are offered by private insurance companies. These companies contract with Medicare to provide services, and Medicare pays a portion of the costs of your services. They will cover all of your Original Medicare needs and often offer additional benefits. Prescription drugs coverage, which would normally fall under Medicare Part D, a separate addition to Original Medicare, is also frequently offered as part of a Medicare Advantage Plan.
Many Medicare Advantage Plans offer benefits like wellness programs, eyeglasses, hearing coverage, and dental care. Read the policy carefully to determine what it offers over and above Original Medicare.
Types of Medicare Advantage Plans
Like regular insurance plans, Medicare Advantage Plans have several types that have specific advantages and disadvantages. The type of plan that you choose should depend on your overall health and your anticipated healthcare needs in the near future.
- HMO Plans: A Health Maintenance Organization plan limits the doctors or healthcare providers that you can see to the plan’s network. There is an exception if you need emergency medical attention. You can also often get a referral to go out of network for specialists and other doctors as well.
- PPO Plans: A Preferred Provider Organization plan allows you to go outside of the network, but you will pay less if you use healthcare professionals within a specific network. You will likely pay more to visit a doctor or healthcare provider outside of the network.
- PFFS Plans: A Private Fee-for-Service plan is most similar to Original Medicare. You can go to any doctor, any hospital, or any health care provider as long as they accept the payment terms that come along with that particular plan. The plan will determine how much it will pay doctors, etc. depending on the service. The amount you will pay out of pocket depends on the service as well.
- SNP Plans: Special Needs Plans are targeted to specific groups of people. For example, these plans would likely work well for those who live in a nursing home or those who have both Medicare and Medicaid. It is also beneficial for certain people who have chronic health conditions.
- HMOPOS Plans: An HMO Point-of-Service plan allows some services that are out of network if you pay a higher coinsurance or copayment. They are not as extensive as POS plans, and not quite as limited as HMO plans.
- MSA Plans: Medical Savings Account plans use both a bank account and a high deductible health plan. Medicare makes deposits into the account, and then you can use the money throughout the year for your healthcare related expenses. Unlike other Medicare Advantage Plans, MSA Plans do not have offer drug coverage, so you may have to purchase a Medicare Part D Plan as well.
Costs for Medicare Advantage Plans
In exchange for Medicare’s payment, the companies that offer Medicare Advantage Plans must abide by certain rules and requirements that Medicare sets out. These rules include covering certain services and how much they can charge for your portion of specific services. However, there are things that Medicare cannot control, such as your out-of-pocket costs and how you must get services (such as through a referral to a specialist).
You will likely pay an additional premium for a Medicare Advantage Plan on top of the premium paid for your Part B Plan. Premiums vary a great deal depending on the type of plan. As of 2016, the Part B premium for most people is $109.90 for each month.
The amounts that you pay in addition to your premium in the form of out-of-pocket costs for a Medicare Advantage Plan will vary depending on a wide range of factors.
- Whether the plan pays for any of your Medicare Part B premium
- Whether the plan charges a monthly premium
- How much you pay for each visit (copayment or coinsurance)
- The type of health services you need
- How often you need health services
- Whether there is an annual deductible or any additional deductibles
- Whether you are in network (depending on your type of plan)
- Whether the plan charges for extra benefits (and whether you need these extra benefits)
- Yearly limits on out-of-pocket costs
- Whether you get help for your health care expenses from your state or through Medicaid
You will need to examine a potential policy closely to determine where extra costs may lie.
Finding the Right Medicare Advantage Plan
Just like choosing your insurance plan, finding the right Medicare Advantage Plan is going to depend a great deal on your personal healthcare needs. Some people may not need the extra services provided by Medicare Advantage Plans and can stick with Original Medicare. Others should get a Part C plan because they will use the extra benefits, so it makes getting a plan the cost effective choice.
Keep in mind that not all Medicare Advantage Plans are offered in all areas, to get help finding out what plans are available in your area request more information from HealthMatchup.com. Then, check for:
- Quality ratings provided by Medicare on each plan available
- How much copays and deductibles will be
- Participating healthcare facilities and doctors
- Whether the plan offers benefits like dental and vision coverage
- What prescription drugs cost
Spend some time looking through your options to find the plan that suits your needs—you will be glad you did.