As people age, they begin looking at their Medicare program options. Outside of original Medicare, there are Medicare Advantage Plans. These plans are popular and work well for many Americans, but enrolling has some risks.
Is a Medicare Advantage Plan right for your needs? If you have received Medicare Advantage ads in the mail and online and have been wondering about these plans, consider the pros and cons before enrolling.
What Are Medicare Advantage Plans?
Medicare Advantage Plans are often referred to as Plan C options. Private companies approved by the Federal Medicare program offer Medicare Advantage plans. You should learn about the options and select the one that offers affordable premiums and allows you to receive the coverage you need.
Health Maintenance Organization Plans (HMO)
HMO plans limit you to medical care provided within the network. You may need a referral from your primary doctor to see other doctors or specialists. Out-of-network doctor’s visits may require you to pay a higher co-payment.
Preferred Provider Organization (PPO)
You will save money with this type of Medicare Advantage Plan if you see doctors within the network. You almost always pay more for services outside of the network.
These plans are very similar to original Medicare. If the provider accepts the Medicare Advantage plan terms, you can select your preferred doctor. Like other Medicare Advantage plans, you will pay more for out-of-pocket care.
Special Needs Plans (SNPs)
These plans are for people with special needs, such as those with disabilities. For instance, SNPs are provided for those with Medicare and Medicaid or who live in a nursing home and require specialized care.
HMO plans may allow beneficiaries to receive some services out of network in exchange for paying a higher co-payment. You may be charged a premium in addition to your monthly Plan B payment.
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Pros & Cons of Medicare Advantage Plans
One of the most significant decisions you will make when you reach age 65 is whether you will enroll in original Medicare or a Medicare Advantage plan. There is no perfect answer for everyone, and it is essential to weigh the facts by researching. Remember that you cannot change your plan until open enrollment unless you meet specific requirements, so choose wisely.
Pro: Possible Out-Of-Pocket Savings
Some Medicare Advantage plans offer $0 premiums. These plans can help pay for your Part B coverage if you have a lower income. It is important to note that the plans with $0 premiums may have increased out-of-pocket costs for some tests and other medical services. Research carefully to know what you are paying and the benefits you will receive.
Con: Limited Networks
You are practically unlimited on the doctors and specialists you can see with an original Medicare plan as long as the doctor accepts Medicare. Medicare Advantage plans often have networks they want beneficiaries to stay within. If you go outside of the network, you could pay more.
Pro: Extended Benefits
Medicare Advantage plans offer all the Part A and Part B benefits of original Medicare but often with added benefits. These plans sometimes include vision, dental, and eye care coverage, benefits that original Medicare alone does not provide.
Con: Prior Authorization Headaches
Medicare Advantage plans require beneficiaries to get prior approval to see a specialist or undergo some medical treatments and testing. Prior authorization can lead to headaches for beneficiaries, who could be delayed in receiving necessary medical care.
Pro: Improved Coordinated Care
Medicare Advantage plan members often have a plan of care and case management that reviews their prescriptions to ensure the treatment plan is effective. Many people state they are happier with Medicare Advantage plans over original Medicare. According to one recent study, over 90% of enrollees were satisfied with their Medicare Advantage plan.
Con: Delays in Seeing Doctors
Many people report delays in being able to visit doctors outside of their network. Beneficiaries report waiting over a month to see doctors and up to three weeks for outpatient hospital care. Wait times can sometimes be lengthy with original Medicare, too.
Get More Information About Your Options
There are many Medicare Advantage Plan providers, and choosing one can sometimes feel overwhelming. Research is critical before deciding. You can research your plan options by visiting the Medicare.gov website this website. Here, you can use the Medicare Plan Finder, which allows you to compare different options.
You can enroll in original Medicare or a Medicare Advantage plan as soon as three months before you turn 65. Open enrollment is between October 15th and December 7th. You can review your Medicare plan and make changes according to your needs during this time.
Medicare Advantage plans are not for everyone; some prefer sticking with original Medicare. No matter which you choose, you will have access to Part A and Part B Medicare coverage. Some Medicare Advantage plans offer other benefits, including Part D, which covers prescription drugs. Choose carefully and get the federal coverage you deserve.
Editor’s Note: The opinions expressed here by the authors are their own, not those of Impakter.com — Featured Photo Credit: Unsplash.