With the start of Medicare’s Open Enrollment this month, expect a flood of TV commercials for Medicare Advantage Plans. The ads have one aim: to convince you to sign up. But when it comes to Medicare Advantage: Make Certain It’s the Right Plan For You.
The commercials will promote the benefits of many different plans. Some may sound perfect for you. But are they? Before signing up for a plan, understand the details and whether it meets your needs and budget.
What are Medicare Advantage Plans?
Medicare insurance is provided either through Original Medicare or through Medicare Advantage Plans. From October 15th to December 7th, the period of Medicare’s Open Enrollment, those who qualify for Medicare can join, drop or change their plans.
Original Medicare is run by the government agency, the Centers for Medicare & Medicaid Services (CMS) and includes Part A (Hospital Insurance), Part B (Medical Insurance), and Part D (Prescription Insurance). You can also purchase a Supplemental Medicare Insurance (Medigap) from a private company to cover Medicare co-pays and deductibles.
Medicare Care Advantage Plans, sometimes referred to as Medicare Part C, are run by private insurance companies and are an alternative to Original Medicare. They bundle Parts A and B and usually Part D into a single plan. Medigap is not needed.
Do you Qualify for a Medicare Advantage Plan?
To qualify for a Medicare Advantage Plan, you need to:
- Have Part A and Part B.
- Live in the plan’s service area.
- Be a United States Citizen or be lawfully present in the U.S.
Medicare Advantage Plans vary region by region. If you see a plan you like on TV, you will need to verify that it includes your address.
What type of plan is it?
There are different types of Medicare Advantage Plans:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNP)
- Medical Savings Account (MSA)
The type of plan matters as it determines what doctors you can see. With Original Medicare, you can go to any doctor or hospital in the United States that accepts Medicare. With Medicare Advantage, you may be limited to the doctors and other providers in the plan’s network and service area. If you want to keep your current doctor, make certain he or she is in the plan.
What are the costs?
Some of the costs to consider when evaluating a Medicare Advantage plan include:
- Some plans have a premium, some have none.
- Deductibles, co-payments and co-insurance.
- Cost of drug coverage, if not included.
- The plan’s yearly limits on out-of-pocket costs.
- The type of health care services you receive.
Are Medicare Advantage Plans free?
If you choose a plan with a $0 premium, it is not free. You still need to pay your Medicare Part B premium and any higher income premium adjustments. If you worked for less than 40 quarters you will need to pay a Part A premium. The Centers for Medicare & Medicaid Services (CMS) uses these funds to pay the private insurance companies for each beneficiary enrolled in their Advantage Plans. This is to cover the beneficiaries’ expected healthcare costs.
What are the benefits?
Medicare Advantage Plans must cover all the medically necessary services that are included in Original Medicare. Medicare Advantage plans may cover additional benefits such as vision, hearing and dental care. Some include fitness programs or have other unique benefits.
Can I sign up and forget it?
The insurance companies offering Medicare Advantage Plans are permitted to modify their plans each year. They can, for example, change out-of-pocket costs, whether you need a referral to see a specialist, even the area that it covers. Your plan is required to send you an Annual Notice of Change by September 30. You will want to review this for any changes beginning January 1. If there are changes that do not work for you, you may want to switch plans.
What if I don’t like my plan?
If you enroll in a Medicare Advantage Plan and decide you do not like it, from January 1 to March 31 you can switch to another Advantage Plan or return to Original Medicare. The change begins the first of the month after the plan receives your request. You can also make a change during the annual Open Enrollment period from October 15 to December 7. This change begins January 1.
Where can I get information and help?
Two helpful Medicare resources that explain Medicare Advantage Plans in detail are:
- Understanding Medicare Advantage Plan
- Medicare and You: The Official U.S. Government Medicare Handbook
To find Medicare Advantage Plans in your area, you can use Medicare’s Find a Medicare Plan online tool.
You can also work with a licensed Medicare insurance agent. To find an agent visit localhelp.healthcare.gov.
If you would like help to evaluate your options you can get free, personalized counseling from your State Health Insurance Assistance Program (SHIP). You can locate your state’s SHIP phone number at Shiphelp.org.
Many people like Medicare Advantage Plans and they are a great option. Before you hastily enroll in a program that sounds wonderful in a TV commercial, do you your homework. With Medicare Advantage: Make Certain It’s the Right Plan For You.
This blog is published to provide you with general information only and is not intended to provide specific or comprehensive advice. Money Care, LLC encourages individuals to seek advice from competent professionals when appropriate.
