Medicare Advantage – Overview
Medicare Advantage is part of the Medicare program. It is designed to offer aid to older people and disabled persons who are eligible.
It is also called Medicare Part C and is provided by private insurance companies instead of the US federal government. Medicare Advantage (MA) plans usually have medical, prescription drug and hospital stay coverage.
How Does Medicare Advantage Work?
Medicare Advantage is generally available for those over 65 years of age or younger people with certain disabilities, along with people suffering from end-stage kidney disease, etc.
Medicare Advantage is a Medicare healthcare plan which is offered by private insurance companies that are approved by Medicare.
This is an alternate plan to the Original Medicare and covers the expenses that are covered under Medicare.
This includes hospital coverage under Medicare Part A and Medicare Part B, apart from hospice care charges. Most Medicare Advantage plans also offer to cover charges for prescription drugs.
Each month, the private companies offering the Medicare Advantage plan receive a fixed amount for plan care. In return, these companies charge out-of-pocket expenses to policyholders.
These companies often create their own set of rules for services. Several Medicare Advantage plans provide additional coverage, which is not paid for by Original Medicare, including hearing, vision and dental-related expenses.
Remember, Medicare Advantage cannot be combined with Medigap (Medicare Supplement Insurance). Medicare directly pays the premium for policyholders in Medicare Advantage plans.
The average monthly premium for a Medicare Advantage Plan is $164 per month.
Are there different types of Medicare Advantage plans?
Yes, there are several different types of Medicare Advantage plans available in the insurance marketplace.
The Health Maintenance Organization (HMO) plans are among the most common types of Medicare Advantage plans.
These make up the majority of the total Medicare Advantage enrollments, PFFS, PPO plans and special needs plans.
To be eligible for these healthcare plans, you should be a resident of the service area and have either Medicare Part A or Medicare Part B.
You may also find MSA (Medical Savings Account) and HMO Point-of-Service (HMOPOS) plans under Medicare Advantage, but these are less common.
Medicare Advantage vs. Medigap vs. Original Medicare – Which is better?
Medicare Advantage plans may often have restrictions imposed by the provider network, which can restrict your choices.
If you choose to get treated outside the network, the insurance may not cover the charges, or you may end up having to pay significantly more.
Original Medicare allows you to use any doctor or medical facility that accepts Medicare assignments.
However, in lieu of freedom, you have to pay less though you may still have to pay a monthly premium for Medicare Part B.
However, the extra expense for a Medicare Advantage plan is significantly less than for a Medigap plan. At times, the Medicare Advantage plan may even have a US$ 0 premium.
Medicare Advantage plans also have a maximum out-of-pocket limit for covered care.
That limits the amount you are expected to pay on top of the monthly premium. As of 2023, the maximum cap on the premium limit for Medicare Advantage is US$ 8,300.
On the other hand, Medicare Advantage plans are often confused with Medicare Supplement Insurance (Medigap).
Both of these insurance plans are offered by private insurance carriers but they cover the expenses in different ways.
For instance, Medigap covers the aspects of treatment under Original Medicare by covering your 20% share of covered charges.
When you seek medical care under this, the majority or all of your cost-share will be covered by Medigap plans. For this, you will still have to pay a monthly premium.
However, Medicare Advantage plans include the same coverage as under Medicare Part A and Part B (and also Part D).
Apart from this, Medicare Advantage also offers additional coverage, such as limited dental coverage or an allowance for over-the-counter medications.
Most Medicare Advantage plans do not have any premium but some participants do need to pay a minimum monthly premium.
How to choose the best Medicare Advantage Plans?
First, you will need to understand your healthcare needs and then decide which type of Medicare plan covers these needs.
If you suffer from a chronic health condition and wish to keep using a specific doctor or healthcare facility, you will need to have health insurance that they accept.
If you need prescription drugs frequently then some plans may offer lower out-of-pocket costs than others.
It is extremely important to choose the right healthcare coverage because it can be a vital factor in critical healthcare situations. Medicare Advantage offers an incredibly vast range of coverage, including that omitted under Medicare Part A or Part B.
You can also consult with your family physician or regular doctor to find out how to take advantage of the Medicare Advantage insurance plans.
I am a dedicated healthcare researcher and an enthusiast specializing in medical grants, medical education and research. Through my articles, I aim to empower healthcare professionals and researchers with valuable insights and resources to navigate these critical aspects effectively.