DO MEDICARE ADVANTAGE PLANS HAVE LIFETIME LIMITS?

Medicare is designed to provide health insurance coverage to people aged 65 or above. The national health insurance program of the US is divided into four parts –

• Part A – Hospital Insurance
• Part B – Medical Insurance
• Part C – Medicare Advantage Plan
• Part D Prescription Drug Coverage

Healthcare providers across the country provide their services to Medicare enrollees as per their contract with Medicare. The article will primarily discuss if the Medicare Advantage Plans offer lifetime limits or not!

Medicare Advantage Plans

These are also known as Medicare Part C and are offered by the healthcare providers who agree to follow the rules & regulations defined by Medicare. It is a combination of Medicare Part A, Part B, and usually Part D. It is designed to help protect you from unexpected medical expenses. These plans set a limit on the out-of-pocket payment each year for covered services.

Most common types of Medicare Advantage Plans to choose from:

• Health Maintenance Organization (HMO) Plans – HMO Plans provide healthcare services from providers which are in the plan’s network. Although in some plans, you may be able to opt for out-of-network services, it may cost you more compared to the in-network providers.
• Preferred Provider Organization (PPO) Plans – PPO plans have network doctors, other healthcare providers, and hospitals. If you have enrolled in PPO plans, you will be charged different rates based on in-network or out-of-network services. Generally, if you visit an in-network provider, you are likely to pay less than an out-of-network provider.
• Private Fee-for-Service (PFFS) Plans – PFFS plans are special payment plans and they offer provider flexibility. The providers are paid as per the procedures used to treat a patient. The cost is not certain under PFFS. The doctors, physicians, or healthcare providers receive a fee or commission for each treatment they prescribe. Patients might need to spend a lot more in this model because they are charged on every visit, for every procedure, and the number of treatments they receive.
• Special Needs Plans (SNPs) – SNPs help people with long-term medical costs having specific diseases or characteristics. SNPs customize their benefits, provider choices, and drug formularies to meet the specific needs of the people.
• Medical Savings Account (MSA) Plans – MSA Plans deposit money from Medicare into a bank account which you can use to pay for your healthcare costs. This only covers the Medicare-covered expenses counting towards your deductible.

Do Medicare Advantage Plans Have Lifetime Limits?

Medicare Advantage plan comes with various benefits such as convenient coverage, personalized plan structures, cost-saving options, and coordinated medical care. Besides these benefits, does it provide lifetime limits? The answer would be no.

Since the health care reform law’s banned, Medicare Advantage plans are governed by earlier laws that outlaw annual and lifetime limits. Therefore, Medicare Advantage plans do not offer lifetime limits as they have to provide better coverage compared to traditional Medicare. However, Medicare Advantage plans have an annual out-of-pocket spending limit for covered medical expenses.

Medicare Advantage Plans also offer the benefits that traditional Medicare does not cover, such as:

• Health and wellness programs
• Non-emergency transportation to approved locations
• Routine hearing, dental and vision coverage
• Over-the-counter medication allowances

Depending on your location, you may find Medicare Advantage Plans with a $0 premium.