How to Know if Medicare Advantage Plan Right for You?

When you reach the age of 65, you must decide whether to keep your Original Medicare or buy additional coverage, such as a Medicare Advantage] (MA) or a Medigap plan. Anyone who is eligible for Medicare (due to age, disability, or end-stage renal disease) should carefully consider whether or not they want supplemental coverage.

We feel that you should not rely solely on Original Medicare. What's to stop you? Medicare only covers up to 80% of your medical expenses at best. Although 80% coverage may appear to be sufficient, the remaining 20% might be extremely costly.

Medigap policies will cover the majority, if not all, of the costs not covered by Medicare, but they can be costly. Monthly Medigap premiums can range from $100 to $200+ each month, depending on your plan, zip code, and age. Here's where you can get a Medigap quotation to see how much it might cost you.

Medicare Advantage: Insurance's Goldilocks?

Medicare Advantage, on the other hand, can be a good balance between Medigap's high cost and Original Medicare's insufficient coverage. Medicare Advantage, like the children's story, can be a Goldilocks solution: "not too firm, 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, equal. There will still be copays and coinsurance with MA, but they will be less than with Original Medicare.

MA often covers more than Medicare Parts A and Medicare Part B. Prescription medications are the finest example. Normally, you would need to purchase a separate Part D plan to have your prescription drugs covered at the pharmacy, but MA covers them by default. Some MA plans also include hearing, vision, and dental coverage.

The Medicare Advantage program is extremely popular. In reality, the number of persons enrolled in MA has doubled in the last decade, reaching 24.1 million.

Is Medicare Advantage the right fit for you?

Here are reasons to think about getting a Medicare Advantage plan.

You don't mind having a limited doctor network.

Original Medicare has a larger network of doctors and facilities, but Medicare Advantage has a smaller network. If you're okay with it, then MA gets a point.

Also Read Do All Doctors Accept Medicare Supplement Plans?

MA plans are typically divided into two networks.

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

PPO plans typically have a national network of providers who are deemed "in-network." You can often see doctors, specialists, or hospitals that are not in your network, but you will likely pay more than you would if they were in your network. MA PPOs offer greater flexibility than MA HMOs, but they are more difficult to locate. If PPO plans are crucial to you, a MedicareServices agent can assist you.

Also Read: What happens when your doctor stops accepting Medicare?

For many consumers, the lack of nationwide coverage might be a deal-breaker. Medicare Advantage is an option if that is not a priority for you.

If you're considering a Medicare Advantage plan, check sure your preferred doctor is included in the plan's network. Our team at MedicareServices.Net can assist you in finding out if your key providers are "in-network."

You enjoy Additional Benefits

As previously stated, MA plans typically provide additional benefits not available through Original Medicare. MA Plans may include transportation to and from the doctor's office, meals, and/or a gym membership. Although these examples are not insurance, you might enjoy the added benefits. Look for MA plans that include dental, vision, and hearing benefits, as they can save you money on coverage that you would otherwise have to purchase individually.

All MA plans provide bundled medication benefits, which eliminates the need for separate Part D drug coverage.

If you choose MA, you will not be able to purchase a separate Prescription Drug Plan (PDP), so be sure your MA plan includes your existing medication list.

You Have A Limited Budget

One of the most significant advantages of Medicare Advantage is that it is less expensive than Medigap. How much less is that? You can acquire MA coverage for virtually nothing more than a few extra dollars. 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, but you will not be charged an additional monthly fee.

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

Final thoughts

You should not limit yourself to Original Medicare. For persons over 65, the high expense of medical bills is the leading cause of bankruptcy, although practically everyone over 65 has access to Medicare. You'll have to come up with a way to fund the costs that Medicare doesn't cover.

If you don't mind certain network constraints and can't pay Medigap, Medicare Advantage is a fantastic option.

For More Information About Medicare Advantage

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