What is Medicare Advantage
Curious about what is Medicare Advantage? You may have already heard about Medicare Advantage plans, but do you know what it is for and how it works? In this article, we will talk and will try to answer your questions about these high-coverage medical insurance plans.
What Do Medicare Advantage Plans Cover?
The first thing we need to understand about any insurance plans is the kind of expenses it will cover for you. Typically, these are expenses that you will pay out of your pockets. Medicare Advantage will fully cover some, if not all, of your costs. Some expenses will only be partially covered under this plan. It means that Medicare Advantage will only pay for a percentage of the entire amount, and the remaining balance will be paid by the patient. Aside from that, a policyholder will also have to pay for the deductibles and co-payments, and these should be paid before you can take advantage of the plan’s coverage.
All covered items in Original Medicare are also included in a Medicare Advantage plan. That will include Medicare Part A and Part B. You get to take advantage of those alongside other medical benefits if you sign up for a policy. In case you missed it, these parts cover inpatient and outpatient expenses at any medical facility. These include medical tests and procedures, in-room costs, ambulance services, check-ups, and prescription drugs, among others.
Beyond the basic coverage provided by Medicare Part A and Part B, Medicare Advantage can also offer coverage for urgently needed medical care, which includes services such as lifesaving medical treatments and medications. It can also cover emergency care, inclusive of emergency room costs.
Those items already cover a significant portion of medical expenses. However, those are just the standard items included in every Medicare Advantage plan. There are, actually, more. Only available through private insurance providers, the cost of a Medicare Advantage plan is set by the insurance companies themselves. Medicare gave them this freedom, but they need to follow the guidelines and meet Medicare guidelines when it comes to offering the plans. Because of this, it is highly-encouraged to compare prices of Medicare Advantage plans from different providers. Doing so will help a would-be policyholder in coming up with a wise decision on what kind of plan to get and whom to get it from.
When it comes to additional benefits, various Medicare Advantage plans offer different sets of medical coverage. A good number of these plans provide Medicare Part D, as well. Also known as prescription drug coverage, Medicare Part D can be acquired as a single, stand-alone plan or as part of a package. You can only choose one, though. You cannot have an independent Medicare Part D if you already have a Medicare Advantage plan that already includes prescription drug coverage.
Some insurance companies also cover the cost of prescription eyeglasses, hearing aids, and others, as well as various check-ups for general wellness, hearing, or vision.
These are just sample items included in the additional benefits provided in Medicare Advantage plans, on top of the basic coverage. Some insurance providers will only sell a basic plan, while some will offer a broad range of coverage options. The good thing is you can always choose the plan you prefer as long as it will address your needs and will be reasonable, in terms of amount.
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Getting Medicare Advantage
To qualify for Medicare Advantage coverage, you need to meet its minimum eligibility requirements. There are only a few items in the list of requirements. Still, the guidelines set pretty strict rules when it comes to qualifying for Medicare coverage.
First and foremost, you should be 65 years old or older to be eligible for Medicare. There are some exceptions, though. Once you turn 65, you can immediately sign up for a Medicare Advantage plan. You also need to be a US citizen to qualify.
Having an Original Medicare is not really a requirement since you will have the same coverage when you sign up for a Medicare Advantage plan. Your medical condition and health status will not affect your eligibility, as well. You don’t have to be necessarily healthy to be covered by such a plan.
You can actually apply even before you turn 65, but you should take note that coverage will only start as soon as you become 65 years old. The best time to apply will be a few months before your 65th birthday.
You also do not have to be working your entire life to be eligible for the coverage of Medicare Advantage. However, if you were able to work for a few years and paid taxes during that period, it can help lower down your costs. You may not have to spend on some premiums, or you may have a chance to avail of reduced rates when you sign up for a plan.
Anytime between October 15 to December 7 is the right time to apply for a plan. This is also called the Open Enrollment Period. If you apply during this period, you will likely get approved. However, application outside of this period may lead to denial of the application. You might need to wait until the enrolment period comes again to reapply.
If you would like to know your chances of getting approved for Medicare or Medicare Advantage plan before you turn 65, you can always consult a Medicare expert. Some people were able to get coverage before they even turned 65. This group of people includes persons with disabilities or those who have been diagnosed with end-stage renal disease.
The Cost of Medicare Advantage
Getting a Medicare Advantage plan will entail paying a monthly premium. The amount will vary from one provider to another. Since they are allowed to set their prices, insurance companies are not restricted when it comes to the premiums, they will ask their members to pay.
It is also important to know that the rates can and may change over a while. Several insurance providers change their plans rates year after year. If you would like to know how much insurance companies sell their plans, you can use a price comparison site to check on those rates. It is the quickest, most efficient way of research. No need to go from one insurance company to another or call them one-by-one.You can do this research while you are inside the comfort of your home. Comparing the different plans available in your area will help you get the most suitable plan that will not only serve your needs but will also work with the amount of money you are willing to spend.
On top of the regular monthly premiums, there are co-payments and deductibles to be paid. These are all part of the Medicare Advantage plan. Depending on the situation, there would be instances when you would not be paying for these. One of these instances is when you have worked and paid taxes for at least ten years. If you did, then you will get an exemption from some of the Medicare payments. A responsible Medicare Advantage agent can help you determine if there will be such exemptions in your case, once you purchase a plan.
Compatibility with other healthcare plans
Not all healthcare plans will work in harmony with Medicare Advantage. If you are currently subscribed to another medical insurance plan, you may have to drop it if you are planning to get a Medicare Advantage plan. This is true, especially when the plan you currently have coverage that will overlap with that of Medicare Advantage. Overlapping benefits is not allowed under Medicare.
One of the plans that will never work with Medicare Advantage is the Medicare Supplement. All types of plans under Medicare Supplement have slightly overlapping medical coverage with that of Medicare Advantage.
You also cannot sign up for a stand-alone Medicare Part D, if the Medicare Advantage plan you are getting already includes prescription drug coverage. That will give you double coverage. Paying twice for the same kind of benefit will do no good as it will only result in conflicting coverage, which is certainly not allowed under Medicare.
The Medicare Advantage plan that you are eyeing to get will also not work with the medical coverage provided by your employer or union. You have to make sure that if you have one, there will be no conflicting coverage once you sign up for Medicare Advantage.
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The insurance network and Medicare Advantage
It is also worth noting that you may or may not get medical coverage anywhere. Not all hospitals would accept your Medicare Advantage plan even if you signed up for the most comprehensive plan. You cannot just walk inside any hospital or doctor’s clinic and expect that the medical insurance that you have will take care of all the expenses. This is because a medical insurance company will have a network of partner hospitals, clinics, and other medical facilities. Not all hospitals may have an arrangement with your medical insurance provider, however. The kind of Medicare Advantage plan you signed up for will determine whether your coverage is only limited within these networks of affiliates or if you can still get full coverage outside the system.
If we are talking about network options and restrictions, there are two basic options when it comes to Medicare Advantage plans. You may either have an HMO or a PPO. There are still other options, but they are not as widely acceptable and accessible as compared to these two.
A PPO plan will give you some, if not full, coverage in a lot of areas, even if you go to a medical facility outside your provider’s network. Since its coverage is broad, it is the most expensive among all the network options. You will get full coverage from a PPO plan if you are getting medical and healthcare services from inside the network. Once outside, you will only get coverage, but it is still better than nothing and can still save you a lot of money.
An HMO plan, on the other hand, is the most affordable among all network options. However, it can only provide coverage inside the network. Absolutely no coverage once you went and availed of medical and health service outside the system of affiliates.
Buying Medicare Advantage Plans
There are a lot of medical insurance companies offering Medicare Advantage plans. This gives you a lot of options to choose from, as each one of them offers different plans at different prices. You have to remember that you can only get Medicare Advantage from a private insurance provider, as they are only ones approved by Medicare to sell these plans. The plans sold by these companies are evaluated yearly by Medicare. If Medicare determines that a particular plan is no longer a good option and does not give value anymore, it may tell the companies to stop selling them.
AARP United Healthcare
Being in the senior care service for a long time now, AARP has offered all sorts of services such as assisted living, financial advice, healthy living plans, and a lot more. It has an expansive line up of insurance plans offered so you will not have any problems finding one that fits your needs. The company is known for giving out excellent benefits for its members, so you will enjoy a lot of perks if you choose to sign up under them.
Mutual of Omaha
This company is known among seniors and industry experts for providing excellent customer service. A nearly flawless customer service record made them a top pick among seniors looking out to buy a Medicare Advantage plan.
This medical insurance company provides a lot of healthy living benefits, and you will get to enjoy those, as well, once you sign up for them. They make sure that they take care of their customers well and that members get the professional medical services they need for their overall well-being. They also offer a wide range of insurance and several Medicare Advantage plans.
Cigna has been at the top rank when it comes to insurance companies offering senior health insurance for decades now. Being at the cutting-edge of the healthcare insurance industry, the company assures that its members stay connected to their insurance coverage by utilizing technologically-advanced services that can be accessed across various devices.
Finding the Best Deal
Having a Medicare Advantage plan will give you the chance to save a lot of money on your medical expenses. For so many years now, it has provided seniors with comprehensive medical insurance coverage that enabled them to cut their costs and live within their means but still gets the medical and healthcare services that they need.
If you want to get that chance too, all you have to do is to do your research on which type of Medicare Advantage plan will work for you. Take time to look at different policies and compare each one in terms of network, coverage, and costs. There are search tools available that can give you different quotes from various companies offering Medicare Advantage.
You deserve to get the right kind of healthcare services, and Medicare Advantage will give you that. It will not only take care of your health but your finances, as well.