Medicare Advantage Plans
Medicare Part C Plans, or Advantage plans, are an amazing way of achieving Medicare benefits. Once you register for Advantage plans, you get the required coverage from a private insurer.
If you look at the benefits, you’ll find that most Advantage Plans offer additional benefits along with Part B and Part A coverage.
Examples of possible additional benefits are routine dental checkups and coverage for prescription drugs.
For registering to an Advantage plan, one must be living in the serviceable region as mentioned by the plan. Also, you should have Part B and Part A of Medicare.
Advantage Plans and Original Medicare
text change here
Most of the time, you’ll get a choice as to how you want to get the Part B and Part A benefits.
You always have the option to enjoy the benefits of Part B, Part A, and Original Medicare. Most people get registered with this program automatically.
However, you should know that there’s no coverage for prescription drugs or dental care. Some situations are exempted, though.
Medicare Advantage plans offer Part B and Part A benefits of Medicare. Also, the majority of Advantage plans help in covering prescription drug expenses.
There are also some extra benefits such as fitness benefits, regular dental coverage, or meal delivery, in some cases.
However, you should know that these benefits aren’t available with every advantage plan.
You can register for this plan from an insurer that is registered with Medicare.
Medicare Advantage Plans 2022
Medicare Advantage: Deep insights into the benefits it offers
The advantage plans offer you coverage for Part B and Part B expenses as given below:
- Urgent Care
- Emergency care
- Doctor Visits
- Ambulance Services
- Outpatient Surgeries
- Skilled nursing services in the hospital
Note: here are some things you need to keep in mind:
- The above benefits or services require you to meet all the Medicare requirements.
- You’ll most probably have to pay for the coinsurance, copayment, or an annual deductible.
- You may also have to stay within the network to enjoy the benefits.
Other Benefit that you may get with Advantage plans
One of the most amazing or respected benefits that you get with Medicare Advantage is the coverage for prescription drugs. The Advantage plans will also offer you coverage for dental care, hearing care, and routine vision care.
Some of the recent Advantage plans offer other benefits like non-medical, home-oriented benefits. These benefits include: –
- In-house safety assessments
In short, you can get prescription drug coverage, coverage for vision, dental and hearing services from an individual advantage plan. Some private insurers may also offer perks like gym memberships.
Total Coverage Cost of Medicare Advantage
Once you register for the Advantage plan, you’ll still have to pay Part B of Medicare premium every month. With some Advantage plans, you may have to pay for an additional premium, while others may not ask for anything extra.
Similar to the Original Medicare plans, the Advantage plans also need cost-sharing. It means you’ll have to pay a particular percentage of the expenses incurred, and the plan will cover the rest.
Certain Advantage plans might require you to pay for a deductible annually. It must be paid before the plan begins to cover your expenses.
You’ll also find several Advantage plans that bring along copayments. It’s a flat amount you need to pay for the services that you get covered by the plan.
One thing which is common for every Advantage plan is the maximum out-of-pocket limit which is an annual expense meant for Part B and Part A expenses. So, when the out-of-pocket expenses reach a certain limit, you won’t have to pay for any service that you incur, as the plan will do that for you.
For the year 2021, the limit cannot exceed $7,550. However, some advantage plans may also offer a lower limit for this service.
Medicare Advantage Plan Networks
Advantage Plans: Plan Types and Provider Networks
The Advantage plans have a network of medical facilities or experts like physicians, hospitals, and even medical suppliers.
The Benefit of working with contracted healthcare facilities is that it helps in keeping the overall plan cost low.
However, a provider network is not mandatory. Some plan types have a network while others don’t. Below, you can find some types of Advantage plans:
HMO: in this Advantage plan type, you get the coverage only if you purchase medical services from the facilities within the plan’s network.
You can get in touch with a physician who’s always there to provide a referral when you need specialist care.
PPO: In this plan type, you can get coverage even if you go outside the network. However, this coverage is partial, and the plan type is costly as compared to the HMO.
But you won’t be needing a referral to visit a specialist as it is in the case of HMO.
PFFS: Here, you need to confirm with the medical facility as to whether or not they accept the plan’s reimbursement as the payment for the service bought.
In case the facility denies, you will pay the expenses.
Medicare Advantage Plans 2022
Advantage plans: Registration or Enrollment
If you have Part B and Part A of Medicare and are residing in the plan’s serviceable area, you can register for Advantage plans.
However, if you’re suffering from ESRD, you won’t be able to register for this plan.
In this situation, you can apply for the SNP or Special Needs Plan.
Find the Medicare Advantage enrollment periods
- You can register or Medicare Advantage during the IEP or when you first become eligible
- You can also register or switch the Advantage pans during the AEP, which is between 15th October – 7th December
- If you’re already registered with the advantage plan, you can easily change the plan in the OEP, which is between 1st January – 31st March.
- There are special circumstances/conditions where you can modify the Advantage plan like when you relocate.