Medicare Advantage plans are required to cover all the same benefits as Original Medicare, which includes hospital (Part A) and medical (Part B) coverage.
However, many Medicare Advantage plans also offer additional benefits such as vision, hearing, and dental coverage, as well as prescription drug coverage (Part D). Some plans also offer coverage for wellness programs, such as gym memberships, and other additional benefits.
Enrollment in a Medicare Advantage plan is optional, and individuals who enroll in one must continue to pay their monthly Medicare Part B premium in addition to any premium for the Medicare Advantage plan. Some Medicare Advantage plans have no additional premium, but others may have a monthly premium. It’s important to note that when you enroll in a Medicare Advantage plan, you generally have to get your care from providers who participate in the plan’s network. However, some plans offer out-of-network coverage, but it may be limited or more expensive. Also, if you have a Medicare Advantage plan, you usually can’t use a Medigap policy to pay for costs that the plan doesn’t cover.
Rules and Cost
Another thing to consider is that each Medicare Advantage plans can have different rules and costs, so it’s important to review the plan details and compare the costs and benefits before enrolling in one. The Annual Enrollment Period (AEP) is the time of the year when you can enroll in or switch Medicare Advantage plans, it typically runs from October 15 to December 7.
Overall, Medicare Advantage plans offer an alternative way to receive your Medicare benefits, with the potential for additional benefits and lower out-of-pocket costs, but also with limitations on provider networks and additional costs, such as premium payments.
Top 5 Pros & Cons Of Signing Up For A Medicare Advantage Plan
Many Medicare Advantage plans offer additional benefits such as vision, hearing, and dental coverage, and prescription drug coverage (Part D) which Original Medicare doesn't cover.
Lower Out Of Pocket Costs
Many Medicare Advantage plans have an out-of-pocket maximum, which is the most you will pay in a calendar year for covered services, this can be lower than the out-of-pocket costs with Original Medicare.
Medicare Advantage plans provide all your Medicare coverage in one place. Instead of having to enroll in separate Medicare plans for hospital, medical, and prescription drug coverage, you can get all of your coverage through one plan.`
No Claim Forms
With a Medicare Advantage plan, you don't have to file claim forms when you get medical care. The plan pays the providers directly
Many Medicare Advantage plans have networks of providers that you can choose from, this can provide more options for care and can help keep costs low.
Limited Provider Networks
Many Medicare Advantage plans have networks of providers that you must use in order to receive coverage. If you have a preferred doctor or hospital that is not in the plan's network, you may have to pay more out of pocket or switch to a different provider.
Limited Coverage Outside Service Area
Medicare Advantage plans typically only provide coverage when you're in the plan's service area, which means you may have to pay more out-of-pocket for care received outside of the service area.
While some Medicare Advantage plans have no additional premium, others may have a monthly premium in addition to your Medicare Part B premium. Additionally, some plans may have higher out-of-pocket costs for certain services.
Medicare Advantage plans can have specific rules and requirements that you must follow, such as getting prior authorization for certain procedures. This can be limiting, and if you prefer more flexibility in terms of choosing your own providers and treatment options, Original Medicare might be a better choice.
Medigap Policies Cannot Be Used
If you enroll in a Medicare Advantage plan, you usually can't use a Medigap policy to pay for costs that the plan doesn't cover. Medigap policies are insurance policies that supplement Original Medicare and can help pay for out-of-pocket costs.
The Bottom Line
Is Medicare Advantage Right For Me?
Whether Medicare Advantage is right for you depends on your individual needs and preferences. While Medicare Advantage plans can have some advantages, such as additional benefits and lower out-of-pocket costs, they also have some limitations. It’s important to consider the following factors when deciding if a Medicare Advantage plan is right for you:
- Your current health status and future health needs: If you have a chronic condition that requires frequent doctor visits or specialized treatment, a Medicare Advantage plan with a large provider network and additional benefits may be a good choice.
- Your budget: Compare the costs of Medicare Advantage plans, including monthly premiums, deductibles, copays, and coinsurance, with Original Medicare and any other coverage you have to see if a Medicare Advantage plan is more affordable for you.
- Your preferred providers: Check if your preferred doctors, hospitals, and other providers are in the plan’s network and if the plan has any restrictions on where you can get care.
- Your prescription drug needs: If you take prescription drugs, check if the plan covers your drugs and if the cost is affordable.
- Your travel habits: If you travel frequently or plan to live outside of the plan’s service area for an extended period, a Medicare Advantage plan may not be a good choice.