When you sign up for Medicare, you have the option to choose between Original Medicare and an all-in-one bundle package known as Medicare Advantage. Medicare Advantage also works to provide policyholders with everything they would get with Original Medicare, with additional coverage built-in.
Medicare Advantage may be right for you because of needs that go beyond what Original Medicare can cover, but it doesn’t stop there. Your physical condition and financial situation can make Medicare Advantage your best option. And no matter what choice you make, you can still make adjustments when necessary.
What does Medicare Advantage do that Original Medicare doesn’t?
Original Medicare covers a broad spectrum of medical treatments and services, including inpatient and outpatient care. Original Medicare is thought of as one plan, but it’s actually the combination of two plans – Medicare Part A (inpatient) and Medicare Part B (outpatient). These are available for separate purchase, but most policyholders have both.
Whether Medicare Advantage is right for you can be because of Original Medicare’s limitations. Original Medicare won’t cover dental, vision, or hearing services, and it doesn’t provide higher discounts for certain physicians in your area.
Medicare Advantage covers dental, vision, and hearing, plus it offers gym memberships in some cases. Some Medicare Advantage plans come with prescription drug coverage and allow policyholders to get higher discounts for specific healthcare professionals.
What if I am on Original Medicare and want to switch?
You may discover that Medicare Advantage is ideal for you later on. With Medicare, you’re never tied to a policy for life. There is an enrollment period created for this purpose.
From October 15 to December 7 each year, you have the ability to switch from your Original Medicare plan to Medicare Advantage. This is known as the Annual Election Period. Once you sign up, your coverage will become effective on January 1 of the following year.
What makes Medicare Advantage convenient?
Without Medicare Advantage, you would need to enroll in other types of policies separately if you want the same amount of coverage.
Medicare Advantage gets you extra coverage faster. If you have Original Medicare and you need to get dental insurance, you’d have to go through more phone calls and forms to fill out. And for separate insurance policies, some can require more than a year of paying premiums before they go into effect.
This not only saves you on time – it also spares you from dealing with out-of-pocket minimums and coverage maximums.
How can Medicare Advantage be personalized?
Medicare Advantage is customizable in ways Original Medicare can’t. There’s no single Medicare Advantage policy. It’s made up of many types of policies with their own strengths and demographics.
A Medicare Advantage plan can come in the following forms:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- HMO-Point of Service (HMO-POS)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP)
- Medicare Savings Account (MSA)
HMOs are usually what come to mind when discussing Medicare Advantage’s benefits and drawbacks. Most HMOs have drug coverage in addition to the inpatient and outpatient coverage, with coverage only applying if you get care within your plan’s network. Outpatient care isn’t covered, but you can get an HMO-POS – a modified version that can allow for out-of-network coverage.
PPOs are more relaxed when it comes to out-of-network coverage. If you are someone who travels and wants all-in-one coverage, a PPO can be right for you. And a PPO is especially right for you if you get treatments from a select few medical professionals, as your plan will offer the greatest discounts for certain physicians within the network.
If you prefer to have a fixed price for your treatments, you can get a PFFS plan so that you can know your costs ahead of time.
SNPs can make Medicare Advantage the absolute best policy for you depending on your health or financial situation. As a result, this can save you more than any other type of Medicare policy while providing coverage specific to treating your condition. SNPs come in multiple forms – Institutional (I-SNP), Chronic (C-SNP), and Dual Eligible (D-SNP). I-SNPs are for those living in institutions such as nursing homes. C-SNPs offer coverage directly for treating chronic and disabling conditions, such as End-Stage Renal Disease (ESRD) or chronic heart failure. If you are in an adverse financial situation and qualify for Medicaid, a D-SNP can save you significant costs, in which your plan can cover certain premiums for you.
If you prefer a separate account that builds in value that you can make payments with, an MSA may be what you need. Here, your plan will deposit funds into your account to help you pay Medicare-related costs. These funds won’t disappear if you don’t use them. The amount you have in your account at the end of the year will still be there the next year.
I already have Medicare Advantage – what if I want to enroll in a different Medicare Advantage plan?
You can do this at two different parts of the year during the Annual Election Period (October 15 to December 7) and the Medicare Advantage Open Enrollment Period (January 1 to March 31).
In either case, if you would like to switch to a Medicare Advantage plan that better suits your needs, you can do so during these times.
It should be noted that Medicare Advantage plans are contractually based and you are required to renew your policy every year.
How can I find out more?
At Medicare Peace of Mind, we give you the ins and outs of Medicare Advantage and help you examine your options so that you get the best plan that fits your wants and needs. We are your go-to for everything related to Medicare, be it Medicare Advantage or other plans.
Give us a call today at 970-233-0633 to learn more about your Medicare options.
