Medicare Advantage plans—also known as Medicare Part C—provide an alternative to Original Medicare. These plans are legally required to offer at least the same benefits as Original Medicare, but often include additional benefits. Is a Medicare Advantage plan right for you? Let’s take a look at the benefits and considerations when it comes to Medicare Advantage plans.
Medicare Advantage Plan: The Benefits
- Medicare Advantage can offer additional coverage.
Medicare Advantage plans are required to offer the same basic benefits as Original Medicare (Medicare Part A and Medicare Part B), but many Medicare advantage plans may also offer additional benefits such as vision, dental, prescription drug coverage or wellness programs. - Medicare Advantage plans can often lower your total annual costs.
If you enroll in a Medicare Advantage plan, you’re still required to pay a Part B premium, but some areas have Medicare Advantage premiums as low as $0/month.2 Additionally, Medicare Advantage plans often limit out-of-pocket expenses, and once you’ve spent that maximum, you shouldn’t have any out-of-pocket costs for the remainder of the year. - Medicare Advantage plans can coordinate & customize care.
Medicare Advantage plans often include managed care and have networks of healthcare providers. For example, members of a Health Maintenance Organization (HMO) Medicare Advantage plan can utilize a primary care physician who can coordinate care and make referrals to specialists. Some individuals prefer this type of approach, especially as it encourages preventative care and screenings.
Additionally, you have the flexibility to find a Medicare Advantage plan that fits your unique healthcare needs instead of purchasing a general plan that might only cover some of your needs or too much coverage than necessary. - Coverage under one plan.
Not only does Medicare Advantage plans offer the hospital and medical care benefits of Parts A and B, but they often also include additional coverage such as dental, vision or prescription drug coverage. Having all of your healthcare needs covered under one plan can help simplify your Medicare coverage.
Medicare Advantage Plans: What to Consider
- Limited choice in primary providers.
With Original Medicare, you can go to almost any doctor or facility that accepts Medicare and receive the same level of benefits. Medicare Advantage plans, however, work within specific networks, which could potentially limit you to certain providers. A plan that fits your specific needs might outweigh the provider you see, but to some, the choice of primary care doctor takes priority. - Referrals and plan authorizations.
Medicare Advantage plans try to help prevent the misuse of health care through various means, which might include prior authorization for hospital stays, home health care, the use of specific medical equipment or certain procedures. This doesn’t mean you no longer have access to this kind of care, you just might need a referral from your primary care doctor before services are paid for. - Specific service areas.
Medicare Advantage plans tend to have regional—rather than nationwide—networks of participating providers, so you’ll have to ensure you’re enrolled in a Medicare Advantage plan in your specific area. This can be particularly tricky for individuals who divide their time between homes in different areas throughout the year. Learn more about Medicare Advantage plans by state.
Learn more about Medicare Advantage Plans with SelectQuote.
Generally, Medicare Advantage plans provide a strong alternative to Original Medicare. From additional benefits to potential low costs, it’s at least worth comparing your options. At SelectQuote, we can help you do exactly that, by getting to know your needs and showing you both coverage and rates available to you from some of the most trusted insurance carriers in the U.S. The service is free and there’s no obligation to enroll.
1https://www.cms.gov/newsroom/press-releases/cms-releases-2022-premiums-and-cost-sharing-information-medicare-advantage-and-prescription-drug
2This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048 ), 24 hours a day/7 days a week or consult www.medicare.gov.
SelectQuote is a licensed and certified representative of a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.
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