Last Updated on by lizzy
Medicare Advantage, also known as Medicare Part C, is a popular health insurance option for adults aged 65 and older in the US. However, choosing the right plan among the 4,064 available nationwide can be complex. To simplify the process, seek help from an impartial health insurance agent or focus on top-quality insurance companies. Consider factors like network size, benefits, and coverage.
Blue Cross Blue Shield
- Offers plans in 47 states and Puerto Rico
- Additional benefits can include dental, vision, hearing, lifestyle and transportation
Humana
- Offers plans in all 50 states, Washington, D.C. and Puerto Rico
- Additional benefits can include dental, vision, hearing, lifestyle and transportation.
- Offers plans in all 50 states
- Additional benefits can include dental, vision, hearing and lifestyle
Aetna
- Offers plans in 46 states and Washington, D.C.
- Additional benefits can include dental, vision, hearing and lifestyle
Cigna
- Offers plans in 26 states and Washington, D.C.
- Additional benefits can include dental, vision, hearing, lifestyle and transportation
Anthem
- Offers plans in 14 states
- Additional benefits can include dental, vision, hearing, lifestyle and transportation
How does Medicare Advantage work?
Medicare Advantage plans are provided by private insurance companies approved by Medicare. These plans combine the coverage of Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan.
Factors to consider When purchasing a Medicare Advantage plan
Coverage
Determine if it meets your specific healthcare needs.
Cost
Consider the monthly premium, deductibles, co-payments, and coinsurance associated with the plan.
Network
Check if your preferred healthcare providers, hospitals, and pharmacies are included in the plan’s network.
Prescription Drugs
If you require medications, review the plan’s formulary to ensure your prescriptions are covered. Evaluate the co-payments or co-insurance for the medications you regularly take.
Additional Benefits
Some Medicare plans offer extra benefits such as dental, vision, hearing, fitness programs, or wellness services.
Prior Authorization and Referral Requirements
Determine if the plan requires prior authorization for certain services or referrals to see specialists. These requirements can impact your access to care.
Star Ratings
Medicare assigns star ratings to Medicare Advantage and Part D plans based on factors like quality of care and customer satisfaction. Consider higher-rated plans for potentially better service and outcomes.
Enrollment Periods
Be aware of the specific enrollment periods for Medicare plans, such as the Initial Enrollment Period, Annual Enrollment Period, or Special Enrollment Periods. Make sure you understand the deadlines to avoid any coverage gaps.
Customer Service
Research the reputation and customer service track record of the insurance company offering the plan. Prompt and helpful customer service can greatly enhance your overall experience.
Personal Health Considerations
Finally, consider your unique health needs, such as chronic conditions or specific medical requirements, and choose a plan that provides adequate coverage and support for those needs.
What Do Medicare Advantage Plans Cover
Medicare Advantage plans, also known as Medicare Part C, provide coverage beyond what is offered by Original Medicare (Part A and Part B). While coverage can vary between different Medicare Advantage plans, they typically include the following:
Hospitalization (Part A)
Inpatient hospital stays, including room and board, nursing care, and necessary medications.
Medical Services (Part B)
Outpatient care, including doctor visits, preventive services, lab tests, medical equipment, and necessary supplies.
Prescription Drugs (Part D)
Many Medicare Advantage plans include prescription drug coverage.
Additional Benefits
Dental care, vision care (including eyeglasses and exams), hearing aids, fitness programs, transportation to medical appointments, and over-the-counter allowances for certain health products.
Specialized Care
This includes chiropractic services, acupuncture, mental health services, or rehabilitation therapies (e.g., physical, occupational, or speech therapy).
Emergency and Urgent Care
This includes ambulance services , emergency room visits and urgent care services for non-life-threatening conditions.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans available. The most common types include:
Health Maintenance Organization (HMO) Plans
With HMO plans, you typically need to use doctors and hospitals within the plan’s network, except in emergencies. You usually need a referral from your primary care physician to see a specialist.
Preferred Provider Organization (PPO) Plans
PPO plans allow you to receive care from both in-network and out-of-network providers. You have more flexibility in choosing healthcare providers without needing a referral, but you may pay higher out-of-pocket costs for out-of-network services.
Private Fee-for-Service (PFFS) Plans
PFFS plans determine how much they will pay doctors, hospitals, and other healthcare providers, and how much you are responsible for paying. Providers must agree to the plan’s terms and conditions to treat you. Not all providers accept PFFS plans.
Special Needs Plans (SNPs)
SNPs are designed for individuals with specific health conditions or who reside in certain institutions. They tailor their benefits, providers, and drug formularies to meet the needs of those with chronic conditions, institutionalized care needs, or dual eligibility (Medicare and Medicaid).
HMO Point of Service (HMO-POS) Plans
HMO-POS plans combine features of HMO and PPO plans. You generally need to use in-network providers, but you may have the option to go out-of-network for certain services at a higher cost.
Medical Savings Account (MSA) Plans
MSA plans combine a high-deductible health plan with a medical savings account. Medicare deposits money into the account, and you can use it to pay for healthcare services until you reach the deductible. After the deductible is met, the plan covers Medicare-covered expenses.
How to Get Online Insurance in America
United Healthcare Medicare Advantage: Everything You Need to Know
Leave a Reply