ARE MEDICARE ADVANTAGE PLANS WORTH THE RISK?

Medicare Advantage plans are a bundle of Medicare Part A, Part B, and sometimes Part D, which provides all-in-one private medical insurance coverage. Medicare Part C or Medicare Advantage is the perfect alternative to original Medicare.

In the United States, it’s estimated that one out of three people, 65 or above, enroll in Medicare Advantage plans. People use it because it covers services that traditional Medicare doesn’t. However, because of co-payments and other costs, Medicare Advantage plans can be a bit more expensive in some cases. The article will primarily discuss if the Medicare Advantage plans or Medicare Part C are worth the risk or not!

Parts of Medicare

As you are aware that the original Medicare is categorized into four parts, namely:

Part A: It is hospital insurance, which covers hospitalization and is usually premium-free.
Part B: It is medical insurance, which covers outpatient care and doctor visits. People who opt for this generally have to pay a standard monthly premium; higher-income people pay more.
Part C: This is the Medicare Advantage, a combination of both Part A and Part B. It is owned by private healthcare organizations that follow all the norms set by Medicare.
Part D: It offers prescription drug coverage, provided by private insurers.

Medicare Advantage Plans

Medicare Advantage plans, Part C of traditional Medicare, is different as compared to original Medicare. Companies that offer Medicare Advantage plans often provide benefits of both Part A and Part B, and sometimes Part D also.

Cost Management with Medicare Advantage Plans

With these plans, out-of-pocket costs may vary. Generally, if you visit in-network providers, you’re likely to pay much lesser than an out-of-network provider. The network of providers may vary with the plan. Health Maintenance Organization (HMO) plans usually have a limited network of providers. You may get a broader network with preferred provider organization (PPO) plans. Fee-for-service (FFS), Special needs plans (SNPs), and Medical savings account plans (MSAs) are some other types of Medicare Advantage plans.

Medicare Advantage plans have a yearly limit on what you pay out-of-pocket for services covered in Part A and Part B. Once the out-of-pocket limit is reached, you don’t have to pay anything for services covered under part A and Part B.

Coverage Options with Medicare Advantage Plans

All the medically necessary services covered under the original Medicare are also covered by Medicare Advantage plans. These plans cover some extra benefits which are not covered by the original Medicare such as hearing, vision, dental care, routine exams, and more. Part D of Medicare is also included in most of the advantage plans. You might have to get an early approval for some of the services or supply ahead of time for the plan to cover it.

In general, Medicare Advantage plans cost less upfront, but if you need lots of medical care, they can cost more. Switching from one Medicare Advantage plan to another is easy but if you want to switch from the Medicare Advantage plan to the original Medicare, there are chances that you won’t be offered all the access to the Medicare policy which means you can be charged more by the insurer.

Conclusion

Opting for Medicare Advantage plans is not a bad idea. However, before you enroll in one, you are advised to understand what all is covered and how much you would be liable to pay as per the plan selected. Your insurer or healthcare provider can help you with that. Considering the benefits and the costs, you can decide whether Medicare Advantage Plans are worth the risk or not!