Is a Medicare Advantage Plan Necessary?

According to a Kaiser Family Foundation research, by the end of 2020, around 39 percent of Medicare enrollees (over 24 million) were enrolled in Medicare Advantage plans or other Medicare health plans, and their popularity is growing. If you're wondering if a Medicare Advantage plan is good for you, keep reading.

What you need to know about Medicare Advantage plans

The Medicare Advantage programme (also known as Medicare Part C) is a supplement to your Medicare Part A and Part B benefits. Your Medicare benefits are administered by a private, Medicare-approved insurance company rather than the federal government. A Medicare Advantage plan, with the exception of hospice care, which is still covered by Medicare Part A, provides at least the same level of coverage as Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) (medical insurance).

Many Medicare Advantage plans have contracts with health-care facilities, doctors, and other medical professionals and suppliers to provide treatment and services to plan members. This arrangement is known as the provider network of a Medicare Advantage plan. Health-care providers who engage in the network of a Medicare

Advantage plan agree to assist coordinate treatment and deliver services at a lower cost than their typical costs. If you opt to enrol in a Medicare Advantage plan, you may have fewer out-of-pocket expenditures. Costs (such as deductibles, copayments, coinsurance, and premiums) vary per plan.

You must have Medicare Parts A and B and live in the Medicare Advantage plan's service region to enrol in a Medicare Advantage plan.

Why would I require a Medicare Advantage plan?

It is up to you to choose the sort of Medicare coverage that is best for you. Some of the ways Medicare Advantage plans may appeal to some beneficiaries are as follows:

Benefits of Medicare Advantage Plans

Medicare Advantage programmes frequently provide additional benefits than Medicare Parts A and B. Many Medicare Advantage plans contain supplementary benefits, which may include one or more of the following (not an exhaustive list):

• Prescription medicine coverage under Medicare Part D

• Routine eye examinations

• Hearing treatment on a regular basis

• Dental checkups on a regular basis

• Membership to a gym and/or other wellness programmes

You might be able to discover a Medicare Advantage plan that offers the advantages you require. In addition, you may value the ease of having all of your health-care coverage in a single plan rather than dealing with various insurance carriers. It's crucial to realise that paying a premium for your Medicare Advantage plan isn't the only premium you'll have to pay. No matter whatever Medicare Advantage plan you choose, you must still pay your monthly Medicare Part B fee.

Maximum out-of-pocket costs for Medicare Advantage plans

You should be aware that Medicare Advantage plans have a maximum out-of-pocket expense. This maximum out-of-pocket amount is the annual limit (or "cap") on the amount you may have to pay out-of-pocket for covered services. Copayments, coinsurance, and deductibles are examples of out-of-pocket expenses. These limits may differ from one Medicare Advantage plan to the next. If you spend up to the plan's maximum out-of-pocket limit, your Medicare Advantage plan may cover all covered hospital and medical services for the rest of the year. (Your premium costs are not included in your maximum out-of-pocket payments.)

Medicare Advantage plans include HMOs, PPOs, and HMOPOS plans.

You may be familiar with health plans such as health maintenance organisations (HMOs), preferred provider organisations (PPOs), and HMO point-of-service (POS) plans if you had group health insurance coverage through an employer or union plan. HMOs, PPOs*, and HMOPOS plans are other prominent types of Medicare Advantage plans. Aside from the plans you may be familiar with, there are other Medicare Advantage plans known as Medicare Special Needs Plans (SNPs). SNPs are intended to address the unique needs of particular Medicare recipients. If you have both Medicare and Medicaid coverage, reside in skilled nursing facilities or require skilled nursing care at home, or have any of the following chronic medical conditions, you may be eligible for a Medicare Special Needs Plan. Other types of Medicare Advantage plans are also available; however, availability and costs may vary.

You can acquire more precise information about Medicare Advantage plans available in your area by doing any of the following:

• On this page, click the Compare Plans or Find Plans tabs and input your zip code.

• You can also contact us if you want to talk about your Medicare coverage alternatives or if you need assistance comparing Medicare Advantage plans. To talk with one of our qualified insurance agents, please call the number listed on this page.

Except in emergency cases, out-of-network/non-contracted physicians are not required to treat Preferred Provider Organization (PPO) plan participants. We recommend you or your provider to request a pre-service organisation determination before receiving an out-of-network service to determine whether we will cover it. For more information, including the cost-sharing that applies to out-of-network services, please call our customer service hotline or consult your Evidence of Coverage.