How To Determine If Medicare Advantage Plan is Right For You

Tue, Aug 10, 2021 8:14 PM Medicare

When you reach the age of 65, you must determine whether to retain Original Medicare or add extra coverage, such as a Medicare Advantage (MA) or a Medigap plan.

We agree that you do not rely solely on Original Medicare. What's to stop you? Medicare only covers up to 80% of the medical expenses at that. While 80% coverage may seem to be sufficient, the remaining 20% may be extremely costly.

The obvious alternative is Medigap. Medigap programs can cover the bulk, if not all, of the costs not covered by Medicare, but they can be costly. Monthly Medigap premiums will vary from $100 to $200+ per month, depending on your plan, zip code, and age.

 

Here's where you can get a Medigap quote to see how much it will cost you.

 

Medicare Advantage: Insurance's Goldilocks?

 

Medicare Advantage, on the other hand, could be a reasonable balance between the high cost of Medigap and Original Medicare's inadequate coverage. Medicare Advantage, like the children's tale, can be a Goldilocks solution: "not too hard, not too soft, but just right." Let's see if it's the "perfect" fit for you.

Let's start with the basics. Medicare Advantage, or MA for short, is a private insurance company's version of Medicare. It replaces Original Medicare with benefits that are, at the very least, comparable. There will always be copays and coinsurance with MA, but they will be less than with Original Medicare.

Medicare advantage plan usually includes more than Medicare Part A and Part B. Prescription drugs are the perfect example. Normally, you will need to buy a special Part D plan to get your prescription medications covered at the pharmacy, however, MA covers them by law. Some MA policies also provide hearing, vision, and dental coverage.

 

Also Read: How to Avoid Highest Out of Pocket Expenses

 

The Medicare Advantage Plan is extremely popular. In fact, the number of people enrolled in Massachusetts has doubled in the last decade, reaching 24.1 million. More than one-fourth of all Medicare-eligible seniors are enrolled in an MA plan.

 

Is Medicare Advantage the best match for you?

 

Here are the reasons to think about having a Medicare Advantage package.

 

You Enjoy "Additional Benefits"

 

As previously stated, MA plans typically have additional benefits not available via Original Medicare. MA Arrangements can include transportation to and from the doctor's office, meals, and/or a gym membership. While these examples are not insurance, you might appreciate the added benefits. Look for MA policies that provide dental, vision, and hearing benefits since it will save you money on coverage that you would otherwise have to purchase separately.

 

Also Read: Things Senior Health Insurance Doesn't Cover

 

As previously stated, almost all MA plans include bundled drug benefits, which eliminates the need for a separate Part D drug plan.

As an aside, if you choose MA, you would not be able to buy a new Prescription Drug Plan (PDP), so make sure your MA plan includes your current medication list.

 

 

 

You don't mind having a limited doctor network.

 

Original Medicare has a larger network of physicians and hospitals, while Medicare Advantage has a smaller network. If you're okay with it, then MA gets a point.

MA plans are usually divided into two networks.

 

• HMO network: If you have an HMO plan, you will only go to providers or hospitals in the plan's network. These networks are usually regional in scope and do not cross state borders. The only exception will be in the case of an emergency, such as a trip to the emergency room. To see a specialist or have some scans, you'll normally need a referral from your primary care physician.

 

Also Read Tips on How To Choose A Primary Care Doctor

 

 

• PPO network usually has a nationwide network of physicians who are called "in-network." You will also see physicians, specialists, or hospitals that are not in your network, so you would likely pay more than you would if they were in your network. MA PPOs provide more versatility than MA HMOs, but they are more difficult to locate. If PPO plans are vital to you, a Medicare Service agent will assist you.

 

For certain individuals, the lack of nationwide coverage can be a deal-breaker. Medicare Advantage is an option if it is not a priority for you.

If you're considering a Medicare Advantage Plan, make sure your preferred doctor is included in the plan's network. Our team at MedicareService.Net will assist you in finding out if your critical doctors are "in-network."

 

You're working with a limited budget.

 

One of the most important benefits of Medicare Advantage is that it is less costly than Medigap. How much less is that? You can get MA coverage for basically nothing more than a few extra bucks. This is referred to as a "zero premium" policy.

You will continue to pay your Part B premium as usual with a $0 premium MA plan, so you will not be charged an extra monthly fee.

The MA benefits don't end there. All MA policies have an “Out of Pocket Maximum,” which restricts the number of deductibles and co-insurance you must pay per year. When you reach your annual limit, you are finished paying for that calendar year, and your MA provider is responsible for all covered expenses. This will save you tens of thousands of dollars over standard Medicare.

 

 

Final thoughts

 

You should not restrict yourself to Original Medicare. For those over 65, the high cost of medical costs is the leading cause of bankruptcy, and nearly anyone over 65 has access to Medicare. You'll have to come up with a way to offset the costs that Medicare doesn't cover.

If you don't mind those network limits and can't afford Medigap, Medicare Advantage is a fantastic option.

 

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