Prior to the novel coronavirus, there were over 62.3 million beneficiaries of Medicare. 60% of these beneficiaries are enrolled under Original Medicare, while the remaining 40% chose Medicare Advantage plans. Although having less patronage, Medical Advantage has plenty of benefits and is the preferred choice by millions of Americans.
In this article, we’ll be demystifying Medicare Advantage and how it differs from Original Medicare. More so, we’ll help you understand how it works and how you can benefit from it.
The biggest problem people face while choosing the perfect Medicare plan is a full understanding of what each plan entails. Most importantly, everyone is concerned about the Medicare benefits they will accrue from such plans.
What Is Medicare Advantage
Medicare Advantage is a type of Medicare health coverage offered by private companies that partners with Medicare to provide Part A and B benefits to beneficiaries. Medicare Advantage Plans are sometimes referred to as Part C or MA Plans. It’s an alternative to Original Medicare.
It covers all Part A and Part B services and many other services covered solely by Original Medicare beneficiaries.
For instance, Original Medicare covers some medical research study costs, hospice care costs, and some new Medicare benefits for MA Plans beneficiaries.
How Does Medicare Advantage Work?
Medicare Advantage, or Medicare Part C, is a collection of U.S. approved health insurance policies. It includes Medicare Part A and Part B plans and other benefits based on government regulations. Additionally, Medicare advantage offers an extra benefit as private insurance.
Here is a breakdown:
All Medicare Advantage covers hospital visits. The benefits of hospital visits range from surgical procedures, Anesthesia, medication administered in the hospital, and inpatient mental health. These benefits are the same as a normal Medicare Part A plan.
In addition to this, all Medicare Advantage plans also (this is redundant, you already started the sentence with “in addition”) cover major medical expenses like checkups at your doctor’s office. Ambulance services to certain facilities, wheelchair costs, and other durable medical equipment are also part of Medicare Advantage benefits.
Finally, Medicare Advantage plans may also cover the cost of clinical research and outpatient mental health treatments. The plan shares some of these benefits with the Part B plans.
What are the Medicare Advantage Plans?
There are four common types of Medicare Advantage Plans, which are:
1. Health Maintenance Organization (HMO) Plans
Beneficiaries of HMO plans get their coverage from the providers in the plan’s network. However, this does not cover out-of-state urgent care, emergency care, and out-of-state dialysis.
Depending on the plan, you may get out-of-network care and services. But it often comes at an extra cost. Healthcare search can help you guide you through these intricacies when choosing a plan.
2. Preferred Provider Organization (PPO) Plans
PPOs Plans are MA Plans offered by private insurance companies. They have doctors, hospitals, and healthcare providers within the plans’ network.
3. Private Fee-for-Service (PFFS) Plans
A PFFS plan is very similar to a PPO. You can get your health care from any health care provider, hospital, or doctor in most instances. However, there are also other PFFS plans that have networks. When using out-of-network doctors, ensure the doctors agree to the plan’s terms of payment. If you’re having trouble with this, you can always contact your agent with Healthcare search to help guide you through the process.
4. Special Needs (SNPs) Plans
As the name suggests, SNP is for beneficiaries with specific diseases or health challenges. As such, the drugs, benefits, and provider choices are tailored to suit the SNP groups’ particular needs.
What Are the Benefits of Medicare Advantage?
When compared to Original Medicare, MA Plans have a handful of Medicare benefits, including the following:
- Lower out-of-pocket costs compared to its counterpart.
- Most MA plans offer additional benefits that Original Medicare does not cover.
- Most plans cover prescription drugs.
- Some MA Plan offer extra coverage such as hearing, vision, dental, and other health programs.
The Bottom Line
Medicare Advantage remains a number one choice for most Americans because of its numerous Medicare benefits. Whichever MA plan you choose, be sure to understand the full details of its coverage or call Healthcare Search at (985) 273-5822 to get the guidance you need to choose a plan that has the coverage you need with the lowest cost.
Remember, with Healthcare Search, you will not be speaking to a machine, but a personal agent near you that can help you through the process.