Why do some say Medicare Advantage Plans are Bad?
Here are the 3 Top reasons some say Medicare Advantage Plans are Bad!
Some may say Medicare Advantage Plans aka (Part C) are bad due to network provider restrictions, referral requirements, and has hidden costs.
According to the office of aging here in Orange County Florida. They reported…
First let’s go over what is a Medicare Advantage Plan also known as (Medicare Part C). Medicare Advantage plans are an all-in-one alternative to Original Medicare and must follow rules set by Medicare. They are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits, and usually includes Part D (prescription medications). Many of these Medicare Advantage plans cover benefits that Original Medicare doesn’t offer, such as dental, vision, hearing, fitness programs/gym membership, transportation, and over the counter products. In order to enroll in a Medicare Advantage plan you must sign up for Medicare Part A and Part B.
Want to learn more about all medicare options here are Life and Med?
The most common types of Medicare Advantage Plans are
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNPs)
Who can apply for Medicare?
People who are 65 or older and worked in the United States for 10 years/40 quarters and paid Medicare taxes
Certain younger people with disabilities
People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
So are Medicare Advantage Plans bad? Short answer no
Lets go over some keys points of having a Medicare Advantage Plan
Does Medicare Advantage Plans need Referrals to See a Specialists and other providers?
Usually if you have a HMO plan a referral is requires before seeing a specialist. If you have a PPO plan a referral is not needed.
How does Medicare Advantage Plan Network Providers work?
The Plans offer HMO and PPO Plans. HMO-Health Maintenance Organization, you see provides in your plan networks. You can see other providers for Emergencies, out of area Urgent care, and out of area for Dialysis care.
PPO-Preferred Provider Organization, you usually can see doctors out of networks and referrals aren’t necessary.
Medicare Advantage Plans have hidden cost?
Many Plans offer $0 monthly premiums. The Plans do have co-pays, coinsurance, deductibles, and a yearly max out of pocket. So you pay as you go. Example you may have a co-pay of $20 to see your Specialist, $5 for lab work etc. Max of out pocket- Laws are put in place for max out of pockets. This is a good thing. For example if your max out of pocket is $3,000. For that year the plan can’t charge you over that max amount if something Catastrophic happens medically in that year. The max out of pocket do re-set each year.
More and more citizens are switching from Supplement plans due to simply not being able to continue to pay for the monthly premiums of a Supplement plan. Medicare Advantage plans set a limit on what you’ll have to pay out-of-pocket each year for covered services.
What’s the difference between a deductible, coinsurance, and a copayment?
Deductible—The amount you must pay for health care or prescriptions before your insurance begins to pay.
Coinsurance is usually a percentage (for example, 20%).
Copayment—An fixed amount you may be required to pay as your share of the cost for a medical service or supplies, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or for a prescription medication.
Medicare Advantage plans may also cover benefits that Original Medicare doesn’t cover. Coverage for dental care, vision and eyeglasses, hearing aids and prescription drugs are just some of the things that can be commonly found in plans but not included in Original Medicare.
What most people describe as “hidden costs” are often the deductibles, coinsurance or copayments built into the plan. Original Medicare also has deductibles, coinsurance and copayments for both Part A and Part B coverage.
Be sure to go over the deductibles and cost-sharing requirements for any plan prior to enrolling so you know what to expect when you use the policy. When you see plans marketed as having $0 monthly premiums, keep in mind that you likely still have other costs to pay when using the plan, such as those coinsurance or copay costs.
Here are some helpful Tips to know about Medicare Advantage Plans:
When you enroll in a Medicare Advantage Plan it includes all your Medical coverage all in one plan; you get extra benefits such a dental, vision, hearing, etc. Original Medicare doesn’t cover these extra benefits.
You still have the same rights as Original Medicare
You can join a Medicare Advantage Plan even if you have a pre-existing condition.
It’s very important to talk a licensed health insurance broker that is trustworthy, that can go over your options and plan choices in your area. To help you pick a plan the best fits your needs. Picking a plan that helps with the cost of your medications and also your Primary care doctor takes.
Medicare Part C and Medicare Advantage Plans are the something.
Medicare Advantage Plans might require reapproval for certain medical care.
If you are considering enrolling in the plan but are hesitant, we are here to help you make the right decision. The key to obtaining the best coverage for you is thorough researching and becoming educated on your plan options in your area.
