Is Medicare Advantage Plan a Good Option?

Medicare Advantage Plans, also known as Medicare Part C, are an alternative way to get your Medicare coverage. Medicare Advantage Plans are offered by private insurance companies that contract with Medicare to provide all of your Part A and Part B benefits. Some Medicare Advantage Plans may also include Medicare Part D prescription drug coverage. Medicare Advantage Plans must cover all of the services that Original Medicare covers, but they can do so with different rules, costs, and restrictions. Understanding the pros and cons of Medicare Advantage Plans can help you decide if enrolling in one is right for you.

What is Medicare Advantage?

Medicare Advantage, sometimes called Medicare Part C, is an alternative way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans are offered by private insurance companies that contract with Medicare to provide your Medicare benefits. Some Medicare Advantage Plans also include Part D prescription drug coverage.

With Medicare Advantage, you still have Medicare and must continue paying your Part B premium. However, your coverage comes from the Medicare Advantage Plan, not Original Medicare. Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage Plans.

These private companies must follow rules set by Medicare, but they can charge different copayments, coinsurance, or deductibles for the services they cover. The plans can also have different provider networks, prescription drug formularies, and coverage rules.

Types of Medicare Advantage Plans

There are a few main types of Medicare Advantage Plans:

·        HMO (Health Maintenance Organization) - These plans usually limit coverage to doctors and hospitals in their network except in an emergency. You may need referrals to see specialists.

·        PPO (Preferred Provider Organization) - These plans let you see out-of-network providers for higher costs. You usually don't need a referral to see specialists.

·        PFFS (Private Fee-for-Service) - These plans allow you to go to any Medicare-approved doctor or hospital that accepts the plan's payment terms.

·        SNP (Special Needs Plan) - These plans require or are limited to people with certain diseases, specific low incomes, or eligibility for both Medicare and Medicaid.

In addition to these main types, there are Medicare Advantage Medical Savings Account (MSA) plans and HMO Point of Service (POS) plans. Medicare Advantage Plans can also be customized with different features like dental, vision, hearing, health club, and transportation benefits.

Pros of Medicare Advantage Plans

There are several potential advantages to enrolling in a Medicare Advantage Plan:

·        Extra benefits - Most Medicare Advantage Plans include extra benefits that Original Medicare doesn't cover, like dental, vision, hearing, and wellness programs.

·        Prescription drug coverage - Many Medicare Advantage Plans include Part D prescription drug coverage with the medical benefits. With Original Medicare, you need to purchase a separate Part D Plan.

·        Out-of-pocket limits - Unlike Original Medicare, Medicare Advantage Plans must have an annual limit on your out-of-pocket costs for Part A and Part B covered services. Once you hit the limit, you'll pay nothing for covered services.

·        Lower costs - Some Medicare Advantage Plans have $0 premiums or lower premiums than Medigap Plans, and they may have lower deductibles and copays for certain services that Medicare Supplement.

·        Coordinated care - Medicare Advantage Plans generally provide more coordinated  health insurance care since you're dealing with one plan for all your coverage.

·        Innovative care options - Some Medicare Advantage Plans provide coverage for alternate care services that aren't covered by Original Medicare, like acupuncture or fitness programs.

Cons of Medicare Advantage Plans

However, there are also some potential drawbacks to Medicare Advantage Plans to consider:

·        Network restrictions - With an HMO, you may need to see in-network providers to get coverage except for emergency or urgent care. Seeing an out-of-network provider could mean high out-of-pocket costs.

·        Prior authorization - Medicare Advantage Plans may require you to get prior authorization before receiving certain services and procedures. Without it, you may face higher costs or denied claims.

·        Copays and coinsurance - The costs for services like doctor visits, hospital stays, hospital insurance and lab tests may be higher with some Medicare Advantage Plans compared to Original Medicare. You need to carefully compare costs.

·        Medicare Advantage rules - The plan gets to set its own coverage rules in terms of what's covered, prior authorization requirements, drug formularies, provider networks, and more.

·        Plan availability - Medicare Advantage Plans aren't available everywhere, so as Medicare beneficiaries you need to make sure there are plans available in your area.

·        Prescription costs - While Part D prescription drug plan is included, the drug formulary may not cover all your prescriptions, and you may still have copays and coinsurance.

·        Can't use Medigap - You can't pair a Medicare Advantage Plan with a Medigap Plan for supplemental coverage.

Pros and Cons of Original Medicare Plan

Since Medicare Advantage Plans act as an alternative to Original Medicare, it's also useful to understand the pros and cons of sticking with traditional Medicare:

Pros

·        Freedom to choose any Medicare provider nationally

·        No networks

·        Medigap can supplement and fill gaps in coverage

·        Generally pays a large share of covered costs

Cons

·        No out-of-pocket limit

·        You pay 20% coinsurance for most services

·        You pay Part B premium

·        No extra benefits

·        Need separate Part D drug plan

·        No coordination of care

Is Medicare Coverage Right for You?

There are several factors to think about as you weigh Medicare Advantage Plans vs. Original Medicare:

·        Costs -  as advised by centers for Medicare, Compare plan premiums, deductibles, copays, and maximum out-of-pocket costs.

·        Coverage - Make sure the plan covers your medications and preferred providers.

·        Networks - Do the plan's networks include your preferred doctors, specialists, and hospitals?

·        Benefits - Consider if the extra benefits are worth the tradeoffs.

·        Medigap - Decide if you want the option to purchase a Medigap Plan.

·        Prescriptions - Check if your drugs are covered and the pharmacy network.

·        Health status - Your health situation may make Original Medicare or Medicare Advantage a better fit.

Ultimately, there is no one-size-fits-all answer. Medicare Advantage offers some appealing benefits, but also involves tradeoffs. Understanding your options, evaluating plan details, and weighing your personal preferences is key to deciding if it's the right choice.

How to Enroll in Medicare Advantage

If you've determined Medicare Advantage offers you the best value and coverage, you can enroll during certain times:

·        Initial Enrollment Period - When you first become eligible for Medicare, you can select a Medicare Advantage Plan.

·        Annual Enrollment Period - This is from October 15 to December 7 each year. You can switch Medicare Advantage Plans or go back to Original Medicare for the following year.

·        Medicare Advantage Open Enrollment Period - From January 1 to March 31, you can switch between Medicare Advantage Plans or go back to Original Medicare and add a Part D Plan.

·        Special Enrollment Periods - Qualifying life events like moving or losing coverage may allow you to make changes outside regular enrollment periods.

To enroll, find plans available in your area through the Medicare Plan Finder, consider their benefits and costs, and select the plan that best fits your needs. Then you can enroll on the plan's website or by calling them.

Key Takeaways

Medicare Advantage offers benefits like capped out-of-pocket costs, extra coverage, and coordinated care that Original Medicare lacks. However, disadvantages like network restrictions, prior authorization, and Medicare Advantage Plan rules also exist. There's no universally right or wrong choice - you need to carefully compare both options against your specific health needs, preferences, and budget. With smart analysis of the pros and cons and plan details, you can determine if Medicare Advantage or Original Medicare is the optimal coverage decision for your situation.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Bourgeois Insurance a Call at (985) 803-8999. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQS

What is the Medicare Part B giveback benefit?
The Medicare Part B giveback benefit refers to money some Medicare Advantage Plans agree to give back to Medicare Part B premium-paying enrollees each month. By enrolling in a plan that offers this financial incentive, your monthly Part B premium may be reduced or even fully returned to you. It's an extra perk offered by select MA plans to make their coverage more attractive.

 How can I find a Medicare Advantage Plan with a giveback benefit? 

You can use the Medicare Plan Finder tool on Medicare.gov to filter your search for Medicare Advantage Plans in your area that offer a Part B premium reduction.

How much is the standard Medicare Part B premium in 2023?

The standard monthly premium amount most people will pay for Medicare Part B coverage in 2023 is $164.90. However, some Medicare Advantage Plans offer premium reductions that can lower or potentially eliminate this cost. Enrolling in a plan offering the give back benefit is an easy way to save on your Medicare Part B expenses every month.

Am I eligible for a Medicare Advantage Plan with a giveback benefit? 

To qualify for the give back benefit through a Medicare Advantage Plan, you must be enrolled in both Medicare Part A and Part B. This generally means being at least 65 years old and a U.S. citizen or permanent resident. 

How does the Medicare Part B give back benefit work?

Each month, the Medicare Advantage insurance carrier administering your health plan directly pays part or all of your Medicare Part B premium back to you. The money comes as a premium reduction off your plan's costs. F

What other benefits does a Medicare Advantage Plan with a giveback typically provide?

In addition to premium reductions, these plans often include extra coverage like vision, dental and hearing care that Original Medicare does not provide. Many also offer $0 copays for primary care visits and lower prescription drug costs.

How can I compare Medicare Advantage Plans that offer a giveback? 

The Medicare Plan Finder lets you filter your search results specifically for plans offering a Part B premium reduction incentive. This allows easy side-by-side comparisons of options available in your area. 

Is the giveback benefit available with all Medicare Advantage Plans?

No, the give back perk is only offered through select Medicare Advantage Plans. Not every carrier or particular MA plan will provide it. That's why using online tools to filter for plans with the premium reduction advertised is important.