FAQ - Most Frequently Asked Questions about Medicare Advantage
Medicare is the US federal health insurance program for people 65 and above by the government. It is usually divided into multiple plans that provide dedicated coverage for various healthcare situations. Therefore, it is certainly an easy way of providing more choices regarding costs and coverage to consumers. There are two primary ways to get Medicare and Medicare Advantage in the second half of the two parts.
The basic Original Medicare consists of hospital insurance and medical insurance known as Part A and B, respectively. There is also a choice to get a Part D which is the Medicare drug plan. The Medicare Advantageis known as Part C. It is an all-inclusive plan instead of a separate entity to Part A, B, and D. Therefore, it is an alternative to Original Medicare and is available as a bundled “all in one” program.
The main attribute of Medicare Advantage is that unlike other insurance plans covered by the federal government, it is provided by private insurance companies. Medicare pays these companies to cover your Medicare benefits. The companies are Medicare-approved private entities that must follow the dedicated rules set by Medicare to become eligible.
Enrolling in Medicare Advantage or Part C through private insurers can go up to paying $148.50 per month. Naturally, it is a bit more on the pricier side than Part B in addition to the premium charges that go for Medicare Advantage.
Even though there is a wide variation between premiums paid for Medicare Advantage, it has been at its lowest since 2007, i.e., $21 per month. Hence, you may be paying as little as $20 every month, while some of your fellows will take it up to $100 per month.
It is important as a new entrant to compare all types of Medicare Advantage plans based on their coverage, referrals, costs, and premiums, among other things. If you consider yourself a generally healthy person with no underlying conditions, then picking a plan with higher out-of-pocket costs may help you save big on premiums.
On the flip side, if you have underlying health conditions like diabetes that require various tests and diagnostics every month, then a plan with a lower co-pay system will suit you best. We recommend you talk to an expert before a finalized decision to make an informed and knowledgeable choice.
The Health Maintenance Organization Plan, commonly referred to as the HMO, is the primary Medicare Advantage Plan. It provides health care insurance coverage to consumers looking for health care services from doctors, other health care service providers, and hospitals included in the plan’s network. Mostly, HMO plans cover prescription drugs. If your HMO plan doesn’t offer drug coverage, you can opt for a separate Medicare drug plan: Part D.
Preferred Provider Organization Plans or PPO plans are just what their names suggest. It is a Medicare Advantage Plan with a set network of doctors, specialists, hospitals, facilities, and other health care service providers that you can use. Much similar to HMO, PPO is different only at a single attribution of providing out of network services for, indeed, a higher cost.
Therefore, this allows the consumer to choose any doctor, specialist, or health care facility and hospital that isn’t included in the PPO plan’s network if they are willing to pay a higher amount. Consequently, as the name suggests, there are “preferred” health care providers and doctors. You have the option to save money by choosing to go to them.
Medicare Advantage is offered to people 65 and above or younger people who qualify because of special needs or diseases. So even though you may join a Medicare Advantage Plan, you will continue to have the Original Medicare. The difference is that most of part A and B coverage would belong to Medicare Advantage Plan instead of Original Medicare. Hence, there would be little to no need to switch between the original Medicare and Medicare Advantage.
The two main types of Medicare Advantage plans, the HMO and PPO, have different sets of rules regarding referrals. For instance, under HMO, you usually require a referral even before you see an in-network specialist. However, on the other hand, there is no referral required when it comes to PPO, and you can simply choose your preferred specialist without a referral.
Even though the Original Medicare, that is the Part A and B, does not include any sort of routine vision or dental care and checkups, some of the plans under Part C may be able to cover it for you. In fact, it is better than taking up Original Medicare because with a certain Medicare advantage plan Part C that includes both dental and vision, you get all the benefits of the original Medicare anyways.