What Should You Know about Medicare Advantage Plans?

Medicare Advantage, also known as Medicare Part C, is an all-in-one managed care plan that provides the coverage you would find in original Medicare or Medigap, but can also cover prescription drugs such as heart disease, diabetes and cancer.

Most Medicare Advantage plans require beneficiaries to undergo out-of-network health insurance (HMO) for their plans. PPOs allow for high costs – sharing that leaves the network or has no network at all, with HMOs only providing network services. Regardless of which coverage you choose for your prescription medication, it is important to think about which coverage covers which medications you need and how often you take them, as well as where they are purchased. The cost of prescription drugs and the amount of coverage available to you vary according to the plan.

It is important to remember, HMOs offer an entire network of doctors, hospitals and other health care providers who have agreed to accept payment at a certain level for services provided.  A type of plan where individuals pay less if they use providers in the plan’s network. You do not need referrals to see a specialist. If you see an in-network provider, you will only be responsible for a portion of the bill, depending on your plan’s payment structure, according to FoxBusiness.

When considering a Medicare Advantage plan, think about which doctors you see now, what your current medical needs are, such as prescription drugs, and whether or not they are in a Medicare plan. As you prepare to apply for Medicare, you may be wondering about the popular Medicare Advantage Planning option, also known as Medicare Part C.

Medicare Advantage plans 2021 are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits, among other benefits, according to the companies. This is because Medicare Advantage combines the benefits of Medicare Part D, Medicare’s primary health insurance program, and includes Part D of prescription drugs, but without sharing the costs.

These types have a number of benefits that we will discuss in more detail later in this article, such as lower premiums, lower deductibles, and lower ancillary income.

Most people should consider the following three options when researching their health insurance for seniors. Medigap plans are complementary to Medicare and can cover all of its deductibles, copies and co-insurance, but can still offer and supplement additional coverage. While Medicare Advantage does not have a maximum out-of-pocket benefit and offers benefits equivalent to Medicare, it can offer more protection than the original Medicare because it often includes drug coverage and prescription drug coverage.

Take a look at our Medigap overview page and read the advantages and disadvantages of Medigap to see if you are interested.

Prescription drugs are available to regular Medicare participants, but not all prescription drugs are covered in Medicare Advantage plans. Traditional Medicare plans do not cover these services, and out-of-pocket costs would be paid for. Although 82 percent of Medicare plans offer this coverage, those plans are in the minority. One of the benefits of a Medicare Advantage plan is access to additional benefits that can be covered depending on the type of plan, such as nursing homes and assisted living.

Being an advantage depends on your personal situation, from the medication you carry to the prescriptions, but it is an option for everyone.

You should also talk to your Medicare expert about the cost out of your wallet. If you have a Medicare Advantage plan or other type of health insurance for this matter, you will be aware of how much you pay out of pocket each year for Medicare plans. Some of these out-of-pocket expenses may occur after you purchase a Medicaid plan or even after the time you use the plan.

Don’t forget to get the maximum amount out of your pocket for your plan, and before you decide on a plan, ask yourself how well the plan will cover the benefits you need.

Medicare Advantage plans are a great option for many Americans who use Medicare coverage, but if you feel they don’t fit you well, you can supplement your original Medicare plan. You can sign up for a Medicare Advantage plan that covers most of your medical needs without the restrictions of a Medicare Advantage plan, according to the Centers for Medicare and Medicaid Services.

In 2016, the average cost of Medicare Advantage plans was $1.2 billion, $2.5 billion more than their traditional counterparts, according to the Centers for Medicare and Medicaid Services.

This means that seniors who choose a Medicare Advantage plan may have no idea how much it will cost compared to a patient’s original Medicare. For example, certain benefits in Medicare preventive plans may require higher premiums, and the cost of pocket money may be higher than it would be if you were included in your original Medicare program. While Medicare benefits such as deductibles and co-payments for care outside your network limit the amount of care you owe out of pocket, there is a good chance that your “out-of-pocket” payments, which can reach up to $6,700, will not be as high in a Medicaid plan, according to the Centers for Medicare and Medicaid Services, because they limit the amount of debt you have in your pocket.

Medicare benefit plans are sometimes confused with Medicare supplemental insurance plans, also known as Medigap, but they must provide services that are not covered by Medicare, such as hospitalizations covered by Medicare Part A and physician visits covered by Medicare Part B. They also typically include Part D prescription drugs and may include hospitalizations covered by Medicare Part A under the Centers for Medicare and Medicaid Services, as well as some other benefits.

As reported by FoxBusiness, “If you don’t qualify for Medicaid, you may be eligible to get a plan through the Affordable Care Act marketplace. Individuals whose expected 2020 income falls between 100 percent and 400 percent of the federal poverty level (for individuals, that’s $12,490 to $49,960) can qualify for subsidies on their insurance premiums”.