A Medicare Advantage plan is offered by a private insurance company and is approved by Medicare. It is an alternative to Original Medicare for your health and drug coverage. These plans, typically include Part A, Part B, and Part D. It is important to note that Medicare Advantage plans are not considered supplemental Medicare coverage. While they must offer the same benefits as Original Medicare (Parts A and B), each plan may have different rules for receiving services and may charge different out-of-pocket costs. If you enroll in a Medicare Advantage Plan, you still need to pay the Medicare Part B premium, which is currently $174.70.
Medicare Advantage or Disadvantage?
You leave Medicare, and your primary coverage is with an insurance company. Advantage Plans have networks (HMO or PPO), so the doctors and hospitals you can see will be limited. If you want to go to a doctor or hospital, not in the plan’s network, you’d have to pay all or a significant portion of the cost. Additionally, when you travel, you will be considered out of network. These managed care plans require pre-authorization for many medical services and treatments, which could mean delays or denials of medical care.
The plan can determine which doctors you can visit and what treatments you are eligible for. Medicare Advantage plans can be viewed as “pay-as-you-go” plans. The more you utilize the plan, the greater your out-of-pocket expenses will be. With an Advantage Plan, you might encounter significant out-of-pocket costs, up to $8,850 in a calendar year. However, some plans establish lower limits.
If you become dissatisfied with your Advantage Plan, you have the option to switch back to Original Medicare and apply for a Medicare Supplement during the Annual Enrollment Period. It’s important to note that when applying for a Medicare Supplement, you will be required to answer health questions. The insurance company will review your answers and decide whether to accept your application based on this information.
