(GoHealthier.com) – When it comes to Medicare, there are multiple options and parts, which can make it quite confusing for those who are new to enrolling. Medicare Advantage plans are a little different than standard Medicare, and they’re managed by private companies. However, Medicare still pays those companies to administer your benefits.
You may have also heard of Medicare Part C or “MA” plans — those are alternate terms for Medicare Advantage. They provide things you don’t get with the traditional Medicare plan, such as vision, dental, and hearing coverage. You can only access Medicare Advantage if you’re already enrolled in Medicare Part A and Medicare Part B.
Your Coverage With Medicare Advantage
Why do people sign up for Medicare Advantage? It covers additional items that traditional Medicare does not. These plans include Part B, which is medical insurance, and Part A, which covers you if you’re admitted to the hospital.
Additionally, most Medicare Advantage plans cover the following. It’s important to note that not all Medicare Advantage plans are the same, and not all of them cover all of these things, so read your contract carefully.
- Vision exams
- Hearing exams
- Dental cleanings
- Certain wellness initiatives
- Gym memberships
- Transport to medical appointments
Medicare Advantage Plan Types
There are several types of Medicare Advantage plans. These are:
Preferred Provider Organization Plans (PPOs) — With this type of plan, if you stay in a network, you pay less for your medical care. If you go outside your network, it will cost you more.
- Health Maintenance Organization Plans (HMOs) — Unless it’s an emergency, you can only go to medical professionals in a strictly limited network, and you’ll need referrals to go to a specialist in a non-emergency situation.
- Private Fee for Service Plans (PFFS) — With this type of plan, you can go anywhere, but the provider has to accept the terms of the plan. Basically, the plan sets how much it will pay doctors, and doctors will see you if they agree to those terms.
- HMO Point of Service Plans (HMOPOS) — These plans let you go out of network but are otherwise like an HMO, and your fees are higher.
- Special Needs Plan (SNPs) — These are specialized and tailored plans for groups of people who are in specific situations or have specific conditions, such as people in nursing homes.
Generally, Medicare Advantage is preferred if you can access and afford it. That’s because it covers more plans.
Optimizing Your Medicare Advantage Plan
To optimize your coverage, make sure to be aware of your copay amounts and deductibles. About half of Medicare recipients go under Advantage plans now due to the potential to have lower out-of-pocket costs than they would under a traditional Medicare Plan.
However, whether you’ll save really depends upon your circumstances and insurance usage. Some Medicare Advantage plans come with additional surcharges based on income level, while others cover parts of your premium or require a $0 contribution.
If your Medicare Advantage plan provides you with prepaid cards to help you with medications and supplies, it’s important to use the cards. Almost everyone needs things these benefits cover, such as over-the-counter medication and other health supplies.
Most importantly, you can’t be denied Medicare Advantage coverage because you have a pre-existing condition, so some people take full advantage of getting as much treatment as possible as soon as they enroll. If you’ve got elective surgery or something that your doctor feels can be delayed until you’re on Medicare Advantage versus standard private insurance, you may wish to wait until enrollment to save.
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