Cap On How Much You’ll Pay For Covered Services
Unlike traditional Medicare, Medicare Advantage plans have out-of-pocket limits that cannot be more than $7,500 a year for beneficiaries who access care through plan networks. This is especially good for those who have ongoing medical conditions because if you have Parts A and B alone, you won’t have a cap on your medical spending.
Going outside of the network is allowed under many Medicare Advantage preferred provider plans, though medical costs are higher than they are when staying within the plan network. The highest out-of-pocket maximum for health care spending both inside and outside of networks is $11,300 annually.
Why Medicare Advantage Plans Are Badbut Its Not What You Think
It is our opinion that Medicare Advantage Plans are bad because they are mostly improperly explained by the sales representatives.
There are a lot of moving parts to these Plans and when not thoroughly reviewed and discussed with the beneficiary, the outcome could be devastating to the member.
Thus, in these instances, the member believes he/she is enrolling in a plan that may be suitable. However, the unfortunate reality, is that the plan is not suitable for reasons like, accepting physicians, referrals may be required, prescription coverage and more.
Regardless of the reasons, we are here to set the record straight and share a non-biased opinion.
Our agency represents over 25+ top rated insurance carriers with a wide variety of Medicare products to suit your needs. Whether youre looking for a Humana HMO Gold Plus or United Health Care dual-complete plan, we have you covered and we are here to help you.
We strongly advise speaking to a professional Medicare agent prior to signing up for any Medicare plan. That way you can ensure you get the best plan for your individual needs and budget.
Need assistance choosing a Medicare Plan? We are here to help you every step of the way. Give us a call at 866-633-4427 to speak with a licensed agent today.
The Good The Bad And The Ugly Of Picking Medicare Advantage Plans
Editors Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, Ask Phil, aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, Get Whats Yours for Medicare, and co-author of Get Whats Yours: The Revised Secrets to Maxing Out Your Social Security. Send your questions to Phil.
Nearly half of all new Medicare enrollees are signing up for Medicare Advantage plans, which now account for about 35 percent of the entire Medicare market.
The other 65 percent of Medicare beneficiaries are in whats called original Medicare, which consists of Part A and Part B . Those patients usually have a private Part D drug plan, and a quarter have a private Medigap supplement policy.
Medicare Advantage plans must cover everything that original Medicare covers, and they cant discriminate against people who are ill or have preexisting conditions. Anyone, regardless of their health, can get an MA plan or switch to one during open enrollment, which continues through Dec. 7.
Medicare rules have also changed and will permit anyone with an MA plan to switch to another MA plan or opt for original Medicare during the first quarter of 2019 those changes will take effect the month after they have been made.
First, the positive features.
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Medicare Advantage Plans: Are They Good Or Bad
A Medicare Advantage Plan, also called Part C or an MA Plan, combines hospital insurance, medical insurance, and prescription drug coverage into one single plan. Essentially, a Medicare Advantage Plan covers all necessary Medicare services. Some Medicare Advantage Plans include additional coverage for things such as vision, hearing, and dental services. These plans are provided by private health insurance companies that are approved by Medicare. So why do some people think that Medicare Advantage plans are bad?
While rolling all your health insurance into one plan might sound great, there are drawbacks. These plans can sometimes be more complicated and expensive than they seem at first glance. For example, most Medicare Advantage plans entice customers with promises of $0 premiums. In reality, though, they often charge out-of-pocket expenses once people get sick. As always, the devil is in the details. Here we breakdown the positives and negatives of Medicare Advantage plans.
Cons Of Medicare Advantage
- Restrictive plans can limit covered services and medical providers
- May have higher copays, deductibles and other out-of-pocket costs
- Beneficiaries required to pay the Part B deductible
- Costs of health care are not always apparent up front
- Type of plan availability varies by region
- Included medical providers can change at any time during the year
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Coverage Choices For Medicare
Once you become eligible for Medicare, you are not required to sign up for a Medicare Advantage plan. You have several other choices when it comes to traditional Medicare coverage. A Medicare Advantage plan is one choice. Enrollees who select this option will not need to select any other coverage. Remember that MA plans roll all your Medicare coverage into a single plan, and they even provide additional benefits in most cases. You also will not need to worry about Medicare supplement insurance because you cannot enroll in both an MA plan and a Medigap policy.
For those who opt against a Medicare Advantage plan, you may choose to enroll in Original Medicare only. This means that you will receive Part A and Part B coverage directly through the Medicare program. There are no additional requirements for coverage, so Part A and Part B are all that you have to sign up for. Others will choose to add a Part D prescription drug plan to their Original Medicare coverage. These plans are beneficial to people who take regular medications. They can help cover the costs of your prescription drugs.
List Of Medicare Advantage Plans
A Medicare Advantage Plan is sometimes another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow the rules set out by Medicare. Most of the Medicare Advantage Plans include drug plans . In most cases, you may need to use health care providers that are in the network of the plan. Plans sometimes set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some may offer non-emergency coverage out of the network but typically higher costs. Remember to use your Medicare Advantage Plan card to get your Medicare-covered services not your original Medicare Card. However, be sure to keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
Below are the most common types of Medicare Advantage Plans.
- Health Maintenance Organization Plans
- Preferred Provider Organization Plans
- Private Fee-for-Service Plans
For a list of Medicare Advantage Plans..go to
Medicare Advantage Plans Florida
Kentucky and Florida spotlight the diversity there can be from state to state and county to county within the state.
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Why Medicare Advantage Plans Are Bad By David W Bynon Book Review
Medicare has been one of the leading healthcare plans for people in the US. Most particularly, it has been beneficial for those 65 years old and above, some people with certain disabilities as well. While the plan can potentially cover a lot when it comes to healthcare costs, there are a few issues with Medicare in general.
The biggest problem that people often have with Medicare is that to get full coverage, people will have to spend a lot on annual premiums. Understandably, not everyone can afford to pay for such high premiums, so they alter the package to meet their needs foregoing some coverage along the way.
As an answer to the problem, the federal government has launched Medicare Advantage. This is a new package that promises to bundle all of the coverage in Medicare at a more affordable price. From the offset, this seems like a good idea, but there are those that disagree.
MedicareWire.com founder Andrew Bynons book titled Why Medicare Advantage Plans are Bad details Medicare Advantage to its very core. Its a good way to help people understand the upsides and downsides of Medicare Advantage. How do the book and the authors take on the plane fare?
Pros And Cons Of Original Medicare Vs Medicare Advantage Plans
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Most doctors and hospitals in the United States accept Original Medicare. The federal government also limits how much health care providers can charge people on Medicare whether the doctors or hospitals participate in Medicare or not.
All Medicare Advantage plans must cover the same things Original Medicare covers. But Medicare Advantage plans may also cover other benefits such as hearing, vision, dental and prescription drug coverage.
Don’t Leave Your Health to Chance
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They Can Be Expensive
Medicare Advantage plans all come with monthly premiums. Some of them have $0-premiums, but the average monthly premium in 2019 is $28. Some people may think, free, when they hear $0 premium, but thats not necessarily the case. Even if you enroll in a MA plan, you may still be responsible for paying your Medicare Part B premium and other costs, like copayments.
Along with monthly premiums, MA plans can come with high out-of-pocket maximums. An out-of-pocket limit is designed to protect you. Once you reach your limit, the insurance company pays for your covered services. However, some plans out-of-pocket limits can be as high as $6700.
The out-of-pocket limit resets at the beginning of the year, but you could end up paying $13,400 if you have two major procedures within a few months.
For example, if you have hip replacement surgery in November, you might reach the $6700 limit just from that. Then,after your out-of-pocket maximum resets in January, you need knee replacement surgery. You would owe another $6700, just a few months later. You would then be covered for the rest of the year, but that total of $13,400 within a few months can certainly hurt.
How Medicare Advantage Is Different
Medicare Part C is Medicare Advantage. Rather than add to the other parts of Medicare, however, Medicare Advantage plans replace them. Insurers that offer Medicare Advantage are required to provide all the benefits of Part A and Part B, and most plans include Part D drug coverage as well. In addition, the plans typically cover certain expenses that Medicare doesnt, such as hearing, vision and dental care.
Most Medicare Advantage enrollees in 2020 paid no additional premiums for their coverage, other than their regular Part B premiums, according to the Kaiser Family Foundation, a health research group.
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Half Of All Medicare Advantage Enrollees Would Incur Higher Costs Than Beneficiaries In Traditional Medicare For A 5
Figure 5: Medicare Advantage Enrollee Cost Sharing, by Length of Inpatient Hospital Stay, 2020
When Medicare Advantage enrollees require an inpatient hospital stay, many Medicare Advantage plans charge a daily copayment, beginning on day 1. Cost sharing requirements for Medicare Advantage enrollees also typically vary by length of stay. In contrast, under traditional Medicare, when beneficiaries require an inpatient hospital stay, there is a deductible of $1,408 in 2020 with no copayments until day 60 of an inpatient stay.
In 2020, virtually all Medicare Advantage enrollees would pay less than the Part A hospital deductible for an inpatient stay of 3 days. But for stays of 5 days, among the half of Medicare Advantage enrollees required to pay more than the beneficiaries in traditional Medicare, those enrollees would pay $1,644 on average. Nearly two-thirds of Medicare Advantage enrollees are in a plan that requires higher cost sharing than the Part A hospital deductible in traditional Medicare for a 7-day inpatient stay, and more than 7 in 10 are in a plan that requires higher cost sharing for a 10-day inpatient stay.
Pros And Cons Of Medicare Advantage Plans Vs Original Medicare
In addition to the fact that Medicare Advantage plan insurance carriers are generally obligated to sell you a plan, they also bundle additional benefits, such as vision, dental, hearing, and a prescription drug plan . These are valuable benefits that Original Medicare does not cover. For healthy people, these extras make a Medicare Advantage plan a very good deal.
Many of the extra benefits that some insurance plans offer look very enticing, but they often come with limits or high out-of-pocket costs. For example, a plan may have excellent healthcare benefits and a poor Part D plan .
Also, it is important to understand that the extra benefits, including Part D prescriptions, are not included in the plans maximum out-of-pocket limit. So, lets say you use the plans dental coverage and pay $1,500 in copays for restoration work, that $1,500 is not included in your MOOP, nor are your Part D medications. This is why so many people feel that traditional Medicare, plus a supplement plan, dental plan, and a stand-alone Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each… plan are the best way to go.
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Pros And Cons Of Medicare Advantage
Wondering if Medicare Advantage is right for you? Find out what is good about MA.
Like most everything in life there are both pros and cons to Medicare Advantage .
Finding the right Medicare insurance can be rather confusing for seniors, specially when parsing through the 150-page Medicare and You booklet that the government sends out as you approach age 65. We have made a list of the advantages and disadvantages of choosing a MA plan that should help you understand if this product is right for you.
Not included below but also worth mentioning is the fact that Medicare Advantage plans cover the COVID-19 vaccine.
They Went Outside Their Network
Medicare Advantage plans can offer excellent coverage as long as you stay within the plans network! If someone is traveling or sees a physician who is not in their network, they will end up with a much larger bill. That doesnt mean the plan was bad it just means they went outside of their network for service.
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When Original Medicare Coverage Makes Sense
Original Medicare is a better choice if you have serious health conditions or expect them in the future. While monthly premiums may be higher, the coinsurance and other out-of-pocket costs associated with doctor visits and other health care services may be less expensive in the long run.
In addition, you can modify your Original Medicare coverage to help offset your out-of-pocket costs through a Medigap policy and a Medicare Part D prescription drug plan. These offer you combinations of coverage that can further reduce your costs in the long run.
Medicare Supplemental Insurance Medigap
Medicare Supplemental insurance better known as Medigap plans are standardized policies you purchase through private insurers.
To buy a Medigap plan, you first must enroll in both Medicare Part A and Part B. Medigap works with Original Medicare to help you pay out-of-pocket costs that Medicare does not cover, such as copays and coinsurance.
A Medigap plan can reduce your out-of-pocket costs, but it wont pay for all of them.
Medigap does not cover your Plan A deductible. If you were not eligible for Medicare until Jan. 1, 2020 or later, Medigap plans will no longer cover your part B deductible.
It also wont pay for anything that Medicare Part A and Part B does not cover such as vision, dental or hearing services.
You cant add a Medigap policy to a Medicare Advantage plan. You must have Original Medicare.
Medicare and Prescription Drug Coverage
Are Medicare Advantage Plans Worth The Risk
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About 1 in 3 people 65 and older in the U.S. enroll in Medicare Advantage, the private insurance alternative to traditional Medicare. Its not hard to see why: Medicare Advantage plans often cover stuff that Medicare doesnt, and most people dont pay extra for it.
But Medicare Advantage can be more expensive if you get sick because copays and other costs can be higher, says Katy Votava, president of Goodcare.com, a health care consultant for financial advisors and consumers.
Unhappy customers who want to switch back to traditional Medicare may find they no longer qualify for the supplemental policies to help pay their medical bills, or that they would face prohibitively high premiums.
“These are complicated products,” says Votava, author of “Making the Most of Medicare.””Theyre like nothing else, no other insurance that people encounter anywhere until they get to Medicare.”
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