What is Medicare Advantage and How Does it Work?

Taking good care of your health is an essential part of maintaining your general wellbeing. Making sure that your health insurance is up to scratch is a crucial part of this.

Medicare Advantage is a huge benefit which can help you stay in the best possible shape, and keep yourself and your family happy and healthy for much longer.

What Is Medicare Advantage?

Also known as Medicare Part C, Medicare Advantage is a unique way for those who have hospital and medical insurance (Medicare Parts A and B) to access their Medicare benefits.

Offered by a private provider, a Medicare Advantage plan allows you to receive the same coverage as a Part A and B plan. However, it can offer a variety of alternative benefits which may make it a better choice than a traditional medicare plan with a supplement.

The Medicare Advantage program has a wide range of different plans, all of which are fully endorsed and regulated by Medicare. The plans are offered by private insurance providers, giving them more flexibility. Plans are usually funded by monthly premiums, though some areas can provide no premiums at all.

What Is Covered?

In order to qualify, the plans are required to include Plan A and B advantages offered by the classic Medicare packages. Most will also add prescription drug coverage, which is sometimes known as Part D.

In addition, the freedom of these plans allows them to include a wide range of other benefits. These benefits include dental care, fitness programs, hearing, and vision care, and other benefits not present in a traditional Medicare program.

There are also more limitations involved with a Medicare Advantage plan, including limited geographical areas which will vary depending on your plan type. An HMO will require that you attend a doctor or hospital, which is within the provider network offered by the plan unless it is an emergency.

On the other hand, a PPO will enable you to go out of network, but you will have to pay. These plans are therefore not suitable options if you travel a lot, or have more than one residence.

Costs can change from year to year, and this means it is easy to switch to a different, more suitable plan if your needs change. You must be enrolled in Medicare Parts A and B to be eligible for an Advantage Plan.

You can only be refused from an Advantage Plan if you are suffering from kidney failure that requires a transplant or dialysis. It is also worth remembering that Medigap is not eligible for use with Advantage plans, and you will be required to pay all out-of-pocket expenses yourself.

Pros

More benefits

You can receive more benefits than you would be entitled to under a traditional Medicare Plan. The policy will provide the same level of coverage as you would receive under Plans A and B.

Moreover, there are often additional benefits according to your unique plan and individual needs. Vision care and hearing aids can be covered, as can prescription drugs, dental care, and memberships for fitness plans as well as fitness centers.

They can work out cheaper

Despite offering many more benefits, Medicare Advantage plans can wind up costing you less money. You will pay your Medicare Plan B premium as you usually would. Then the type of Advantage plan you choose determines the level of additional premium you must pay. It can be as low as $0 in some cases, leaving you with more cash in your pocket.

You may also find yourself benefiting from lower cost sharing. Visiting a primary care physician under Original Medicare could trigger a coinsurance of 20%, meaning you could pay over $10.

Visiting under Medicare Advantage, however, means you pay a single copayment of $10, which could save you a lot of money in the long run. Any out-of-pocket expenses will also be limited. And, once you have reached the maximum, your costs will be capped for the rest of the year.

You can coordinate care among providers

Medicare Advantage plans tend to have a network of contracted health providers from which to choose. Key examples include HMO (Health Maintenance Organisation) plans, which will ask you to select a Primary Care Physician (PCP) to coordinate your care.

If your plan has prescription drug coverage, you can also benefit from medication therapy management. This results in a smooth, easy, and coordinated care plan which is hugely beneficial to your health, as well as being much more convenient.

You can get everything you need in one place

A Medicare Advantage Plan allows you to cover prescription drugs, health, and wellbeing, all in one plan, making life far more comfortable and more convenient. You can take care of all your health concerns and worries at once. You only have to deal with a single plan administrator, which equals real freedom from endless paperwork and multiple policies!

Cons

As with any issues involving your health, it is essential to consider any negatives carefully, to help you make a confident and informed decision.

Your choice of healthcare providers may have some limitations

Having a limited selection of healthcare providers is the biggest potential disadvantage and may be a dealbreaker for some customers.

Original Medicare means you can visit any doctor’s office that accepts Medicare, and be entitled to the same benefits and level of care. However, because Medicare Advantage works with a strict range of providers, you may find that you are not covered if you use a provider or professional outside of this. This can severely limit your options.

You may have to have your services pre-authorized

In an attempt to reduce the abuse or overuse of healthcare, you may be required to have any procedures pre-authorized by your primary doctor. This can include the use of medical equipment, home healthcare, hospital stays, and medical procedures. This can slow down the process and be frustrating, as you are left waiting around for authorizations or referrals from your doctor for what could be an urgent medical procedure.

Service areas are limited

Most of the providers in the Medicare Advantage network are regional, as opposed to nationwide. To be eligible for enrollment, you are required to you live in the service area for at least six months of the year, making this virtually useless for avid travelers.

Medicare Advantage Bottom Line

Medicare Advantage can be a great plan if you require extra services and coverage that are not available via traditional Medicare. You should be aware, however, that there are restrictions and limitations which can make treatment more difficult. You should think very carefully before you decide to commit to any plan.