Choosing the Best Medicare Advantage Plan: How to Insure Yourself for Services Not Covered by Medicare
Medicare, the health insurance program provided by the U.S. Government for anyone 65 or older who has paid payroll taxes, as well as some individuals who suffer from disabilities, won’t cover every kind of health situation that you may face. Medicare offers basic health coverage, but certain services, like dental, vision, and prescription drug coverage, are not included. That’s why some people opt to join a Medicare Advantage plan alongside Medicare.
What is a Medicare Advantage Plan?
Medicare Advantage is a type of health insurance plan offered by private companies that work with Medicare to provide Medicare Part A and B benefits, and usually additional health coverage not included in these basic Medicare plans.
What does Medicare Part A and Part B cover?
Medicare Part A provides basic hospital service coverage, including in-patient hospital care, hospice, and nursing services.
Medicare Part B provides certain outpatient hospital services, preventative medical services, and physician and surgeon coverage, among others. Medicare Part A and B are included in Medicare Advantage.
What does Medicare Advantage cover?
Not all Medicare Advantage plans are the same. All Medicare Advantage plans cover Medicare Part A and B, but some also cover additional health services, like an annual physical, vision services, dental services, and prescription drugs. Most Medicare Advantage plans offer prescription drug coverage, which is a major reason why participants join these plans. If for some reason a plan does not offer prescription drug coverage, you can join a Medicare Prescription Drug Plan as well.
How does Medicare Advantage work with Medicare to provide your health coverage?
Every month, Medicare will pay a fixed amount to the private company offering you Medicare Advantage. While these companies must follow the rules set by Medicare, they can offer different out-of-pocket costs for every plan. This means there will be different rules for determining the cost and procedures of your health care services depending on which Medicare Advantage plan you choose.
What kind of Medicare Advantage plans are out there?
There are a number of plans, and which one is right for you depends on your unique circumstances. The most popular plans include Health Maintenance Organization plans, where you can only go to a healthcare provider on an HMO list; Preferred Provider Organization plans, where you pay more if you visit a health care provider not on a PPO list; Private Fee-for-Services plans, which determine how much you’ll pay and how much the private company will cover when you’re at the health care provider’s location; and Special Needs Plans, which are only available to individuals with specific diagnosis.
How do I qualify for a Medicare Advantage Plan?
It’s fairly easy to qualify for a Medicare Advantage plan. If you already have Medicare Part A and B, live in the service area of the plan you hope to join, and don’t have End-Stage Renal Disease, you qualify for Medicare Advantage. Remember: if you don’t already have Medicare Part A and B, you will not qualify for Medicare Advantage.
What’s the deal with End-Stage Renal Disease?
Unfortunately, patients with End-Stage Renal Disease cannot join a Medicare Advantage plan. That said, if you are already covered by a Medicare Advantage plan when diagnosed or have a successful kidney transplant, you may be able to stay on your plan.
How much does Medicare Advantage cost?
Costs for Medicare Advantage depend on a number of factors, including whether the plan charges a monthly premium, the kind of health services you need, whether the plan has any deductibles, and more. Every January, a plan will post its new costs, which can change from year to year.