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If you’re 65 or older, you’ve probably already enrolled in Medicare. In fact, in 2018, 17.8% of the people in the United States were covered by Medicare. Most of these are older Americans, although some are permanently disabled or qualify in other ways.
Original Medicare, which is made up of Part A and Part B, offers coverage that a lot of people need. However, it doesn’t cover some services, such as dental and vision care. It also doesn’t cover prescription drugs.
What Are The Advantages and Disadvantages of Medicare Advantage Plans?
If you have Original Medicare, then you pay a monthly premium and a deductible or co-payment when you need services. These costs can add up, and many Americans look for ways to get additional services covered and control their out-of-pocket spending.
Medicare Advantage can be a good choice. What are the advantages and disadvantages of Medicare Advantage plans? Here’s what you need to know.
Understanding Original Medicare
Before you can look at Medicare Advantage, it’s essential to understand Original Medicare. Founded in 1965, the program is designed to provide health insurance for older Americans and is funded through Medicare taxes.
To be eligible, you have to be 65 or older or permanently disabled. If you have end-stage kidney disease, you may also qualify.
Original Medicare is made up of two parts, A and B.
Part A does not have a monthly premium as long as you’ve paid Medicare taxes for a sufficient amount of time. It covers hospitalization, skilled nursing, hospice, and in-home care. Part B has a monthly premium and covers doctor’s visits, preventive care, and outpatient care.
There are also co-payments and deductibles associated with getting treatment under your Medicare coverage. Many times you pay a percentage of the cost, which can be unpredictable.
To get better control of their costs and gain additional coverage, many Americans opt for Medicare Part C, known as Medicare Advantage. What is Medicare Advantage? This insurance is an all-in-one alternative to Original Medicare and is administered by private insurance companies.
Many people choose to use Medicare Advantage instead of adding additional coverage through Medicare Part D and a supplement plan. Here are the reasons it may be a good choice for you — or it may not.
Advantages of Medicare Advantage
For most people, the biggest reason they choose Medicare Advantage is to get additional coverage. For instance, most Advantage plans include prescription drug benefits. You may also gain access to the hearing, dental, and other coverage.
You may also get more predictable out-of-pocket costs. Instead of paying a co-payment of 30% of the cost of the procedure, you might pay a flat fee. This can help you budget for procedures and help you avoid a shocking bill.
The extra benefits will vary from one Advantage plan to another, so be sure you shop around and check the details before you enroll.
Another great benefit is that Advantage plans are very affordable. You have to pay your Part A premium along with the premium for the Medicare Advantage plan, but the extra can be as low as $0.
Finally, your out-of-pocket expenses have a maximum when you choose Medicare Advantage. Once you hit that upper limit, you pay nothing for additional medical procedures. With Original Medicare, there is no upper limit.
To get similar benefits with Original Medicare, you have to enroll in Part D for prescription drug coverage and a Medicare supplement plan as well, which may be costly.
Drawbacks of an Advantage Plan
There are reasons you might not want to work with Medicare Advantage plans, however. One disadvantage of Medicare Advantage plans is that you have to stay within their network of doctors.
If you travel a lot, this may not work for you. Or, if you have a specialist who isn’t listed on your specific plan, you may have to choose another professional.
With Original Medicare, you can see any provider who accepts Medicare. There is no network or limit or change in benefits.
In addition, you might need preauthorization before you can get a specific procedure. Or, you might have to get a doctor’s referral before you can see a specialist or get specific care. This might mean you aren’t able to get the immediate treatment that you want.
Finally, there are situations in which you might face higher costs with Medicare Advantage. If the maximum out-of-pocket limit is high, and you need a lot of care, you could pay more. This article on www.healthstatus.com can tell you more.
Are Medicare Advantage plans terrible? Not for many people. However, if you travel a lot, it may not be for you.
If you have specific providers you must use, be sure to choose a Medicare Advantage plan that includes them in their network. Otherwise, you may be left without coverage for those services.
What Are the Advantages and Disadvantages of Medicare Advantage Plans?
As you can see, Medicare Advantage plans provide essential benefits for a lot of people. However, they are not perfect for every situation.
So what are the advantages and disadvantages of Medicare Advantage plans? The most significant benefit is that you’ll gain additional coverage for minimal cost, even $0 a month!
The biggest drawback is that you have to stay within the provider’s network. If that’s a big concern, be sure you shop around and find an Advantage plan that fits your needs. For those who travel regularly, the original Medicare may be the best choice.