How Do Medicare Advantage Plans Work?

Medicare Advantage plans are a great option for those looking for a comprehensive health insurance solution. Instead of having to sign up for different plans to get the benefits you need, Medicare Advantage rolls the best coverage options available into a single, easy-to-understand plan. Medicare Advantage plans include everything Original Medicare offers as well as a few extra benefits, removing the burden of searching for additional plans to cover what Original Medicare does not. But even with Medicare Advantage’s bundled-coverage approach, it’s important to understand how these plans work and what benefits are available to you.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. You’re still in the Medicare program and have the same rights and protections, but instead of receiving your coverage from Medicare, you receive it from a private insurer approved by Medicare. These plans offer the same benefits as Original Medicare, including Part A (hospital care, care in a skilled nursing facility, or home health and hospice care services) and Part B (doctor visits, lab tests, screenings, medical equipment, ambulance transportation, and other outpatient services). They also typically include Part D (prescription drug) coverage.

So, what is the “advantage” of Medicare Advantage? The real perks of a Medicare Advantage plan come from its additional benefits, which often include vision, hearing, dental, select fitness programs, and more. Some Medicare Advantage plans can even cover transportation to doctor visits, over-the-counter drugs, and some preventative services that promote health and wellness. When reviewing these plans, it’s important to consider which services and benefits are most valuable to you. There’s little sense in enrolling in a plan with extra benefits if you don’t plan to use them.

What Are the Costs Associated with Medicare Advantage?

As with any health insurance plan, you need to understand the costs associated with Medicare. If you choose to purchase a Medicare Advantage plan, you must enroll in both Medicare Part A and Part B first. That means you’ll still need to pay the Part B premium each month. Medicare Advantage plans have their own monthly premiums, which may start as low as $0.

Other costs from a Medicare Advantage plan include your annual deductible, coinsurance, which is a percentage of the cost of a service that you pay after meeting your deductible; and copayments, a set amount you must pay for a health care service, such as a doctor’s visit or prescription.

An important figure to consider when reviewing Medicare Advantage plans is the out-of-pocket maximum, which is the annual limit to what you pay for health care costs. Some costs do not count toward this, such as premiums, Part D costs, and some out-of-network charges.

How Does Medicare Advantage Work?

Medicare Advantage plans come in different forms, including health maintenance organization plans (HMOs) and preferred provider organization plans (PPOs). These are the two most common types of Medicare Advantage plans, and each one comes with different benefits, rules, and restrictions on the types of coverage and providers you can access. The guidelines of these plans can impact how you receive your care, such as whether you need a referral to see a certain specialist.

HMOs usually require you to choose a primary care provider. In addition, you must receive all your non-emergency care from providers within the plan’s network. PPOs, on the other hand, allow you to visit any doctor that accepts your plan, but you may pay less when you visit a provider in your network.

The simplest way to think about Medicare Advantage is that it offers you the ability to customize your health insurance coverage to fit your lifestyle. It allows you to choose the benefits that matter to you, such as vision, dental, hearing, and more. Some Medicare Advantage options can also help those with chronic illnesses better handle the specific nature of their treatment.

Medicare Advantage is a one-stop shop for those looking to simplify their health insurance experience. If that sounds like you, then a Medicare Advantage plan may be the answer you’re looking for.

Interested in learning more about Medicare Advantage? Contact an Advise licensed agent today at (833) 923-1869 (TTY: 711).