Taking care of your loved ones in their senior years is no easy matter. Their immune systems are most likely compromised and in some cases, they would need 24/7 care. However, since young ones live a busy life to make a living, our elders are better off under expert’s care.
Healthcare in the United States is not cheap. But, the government does provide Medicare Plans for elders aged 65 and above. It is a program that will pay for primary health care and save you a lot of money.
However, there are two prominent Medicare plans. The Original and the Advantage plans. But what are their main difference?
Benefits of Medicare Advantage Plan
Both the Original Medicare Plan and the Medicare Advantage Plan consist of the following benefits:
- Hospital insurance (Part A). It helps pay for inpatient hospital care, skilled nursing facility care after an inpatient hospital stay, hospice care, as well as some home health services.
- Medical insurance (Part B). It covers outpatient services such as doctor’s office visits and other medical services not covered by Part A or Part D. It also covers a portion of the cost of most prescription drugs.
- Prescription drug coverage (Part D). This part covers prescription drugs if you enroll in a stand-alone drug plan or choose a Medicare Advantage plan with prescription drug coverage.
However, it is important to note that the Medicare Advantage Plan is also known as Part C in Medicare’s health expense coverage. It works like an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plan you might get from an employer or buy.
It offers the same basic coverage as Parts A and B plus additional benefits offered through private companies approved by Medicare. The benefits you get in Part C are exclusive to the Advantage Plan, providing the enrollees with more benefits. This includes:
- Vision, hearing, and dental services which aren’t covered in the original plan
- Lower out-of-pocket costs
- Exclusive specialty doctors within the plan’s network
How Does Medicare Advantage Plan Work?
Original Medicare is the base version of the program that covers doctor’s visits, hospital stays, and other medical services. It does not cover prescription drugs or most long-term care services.
Medicare Advantage is the alternative version of Medicare provided by private health insurance companies. It can be used in conjunction with Original Medicare or on its own as a full replacement for Original Medicare benefits.
Who is Eligible?
In the case of Medicare Advantage plans, they are not available to everyone, but only those who meet certain requirements. These are:
- You must be enrolled in Original Medicare Parts A and B to enroll in an Advantage Plan
- You can enroll in an Advantage Plan if you are 65 or older
- You must be a citizen of the U.S
There are numerous types of Medicare Advantage plans available. The most common ones include:
1. HMOs, or Health Maintenance Organizations
HMOs are different from other Medicare Advantage plans. They need you to live within their network of primary care doctors. Thus, you must pull up Google and start searching for “primary care doctors near me” and “hospitals near me” to take advantage of the plan.
If you do not live within their service area or choose not to use their providers, your plan will not pay any claims. You will have to pay out of pocket for any non-emergency services received outside the HMO’s network.
2. PFFS Plans, or Private Fee-for-Service Plans
These plans allow you to visit any doctor or hospital without first getting approval from any health plan. This can help reduce out-of-pocket expenses if you use less expensive providers. But, private fee-for-service plans don’t cover all Medicare services. Thus, you may still pay out-of-pocket costs at doctors’ offices or hospitals not covered by your plan.
3. EPOs, or Exclusive Provider Organizations
These plans focus on providing services at in-network hospitals and doctors’ offices. EPO members can still go out of network if they pay higher copays or coinsurance fees than using an in-network provider. These networks are sometimes referred to as narrow networks. They generally include fewer providers than other types of Medicare Advantage plans.
Considerations When Choosing a Medicare Advantage Plan
Medicare Advantage plans are health insurance products that offer different benefits and cost-sharing. There are several things you should look for when choosing a Medicare Advantage plan:
1. Your Primary Care Provider’s Network
Medicare Advantage plan members may have to use a senior primary care, hospitals, and other health care providers. Some plans have national networks, while others operate on a regional or local level.
2. Specialty Care Coverage
Most Medicare Advantage plans offer extra benefits for people with certain conditions, such as diabetes or cancer. The extra benefits can include coverage for medical equipment or prescription drugs. You should check how many specialists are in the network before deciding on a plan.
3. Coverage for Prescription Drugs
Most Medicare Advantage plans include prescription drug coverage, but some charge extra. Some plans also need you to get prior authorization from your doctor before you fill specific prescriptions. Your family doctor must send paperwork to the insurance company before covering a particular medicine or procedure.
4. Services Offered
Most Medicare Advantage plans offer prescription drug coverage, but some don’t. Some also provide more services, such as dental or vision coverage; others don’t have these extras. If you want these services, make sure the plan offers them before signing up.
5. Cost
All private health insurance plans have monthly premiums and copayments. The monthly premium is how much you pay each month to be covered by your insurance company. The copayment is what you pay when you see a doctor or get medical treatment.
Medicare Advantage plans can charge different premiums. It depends on where you live, what coverage they offer, and other factors such as your income or assets. For example, some plans charge higher premiums in areas with high medical costs. Others charge higher premiums for people with higher incomes.
6. Tailored Care Management Programs
Some Medicare Advantage plans offer tailored care management programs. This coordinates all your health care needs under one roof, from doctors’ appointments to hospital stays. These programs also make it easier to access your medical history. This is when a general practitioner near me is required to treat you in an emergency room or urgent care center.
7. Dedicated Customer Service Staff
You’ll have access to dedicated customer service staff who can help answer questions about your coverage. You need to know your claims processing or anything related to your plan’s services or coverage options.
To Conclude
There are many types of plans available to seniors, and it’s important to understand your options. Most Medicare Advantage plans offer extra coverage not included in the Original Medicare plan. This may have dental, vision services, prescription drug coverage, and more.
You may need to choose a Medicare Advantage plan over original Medicare coverage to receive these benefits. Some benefits vary from insurance plan to insurance plan, so you must review them before deciding.