Medicare Advantage Plans, also known as Medicare Part C, are a kind of Medicare health plan offered by a private corporation. The company needs to have a contract with Medicare to provide their employees’ needs and benefits. It is the option to protect a user from the potentially expensive cost that comes with suffering from an accident or illness. Medicare Advantage plans account for over 35% of all the Medicare enrollees.
The rest are enrolled in Medicare Original Plans. This has three basic parts labeled A, B, and D. Part A covers a user’s hospital care while Part B is for doctor fees, medical procedures, and equipment. Part D in Medicare covers prescription drugs. Together, A, B, and D provide basic coverage for all Americans 65 and older.
There are several advantages when it comes to using Medicare Advantage Plans.
First, Medicare Advantage Plan users have access to meet all of their insurance needs through a single insurance company plan. The benefit of dealing with a single entity is an easy advantage due to its convenience.
Next, Medicare Advantage Plans are far cheaper than the original. Most of these plans are starting to charge users with zero premiums after paying the government their monthly B premiums.
The last and best good thing about Medicare Advantage Plans so far is that it covers more than the original plans like dental, hearing care, and vision care. It also covers non-medical benefits such as transportation to doctors’ appointments and the delivery of nutritious meals to patients who are recuperating at home from hospital stays.
A great concern, however, is that federal health regulators have a clear preference for Medicare Advantage plans over the original Medicare plans. This is caused by the want of the people to limit health-care expenses. It is also caused by the desire to improve the services for Medicare employees. Because of this, many people have started to prefer managed care. Medicare Advantage became one of the first choices because of the already existing management policies and networks.
However, with the good comes the bad. Here are the disadvantages of using Medicare Advantage Plans.
Medicare Advantage Plans offer a limited choice of service providers for their users. The available service providers covered by the Medicare Advantage Plan are the companies that belong to their network. This means that some people may have to let go of their relations with trusted practitioners in exchange for the ones within the Plans network.
On the other hand, people who have the original plan can choose the doctor, hospital, and treatment that they receive as long as the service provider accepts Medicare. Almost all service providers across the country accept Medicare, which exponentially broadens their options.
The greatest detriment of Medicare Advantage Plans is that it tends to choose the service provider with the lowest cost. This is the reason why Medicare Advantage Plans can offer more services. The plan saves more money through the agreements with the service providers that are within their network. The services within their networks may be the cheapest, but this might mean that some services have compromised their quality. This may come in different forms like using outdated equipment or being attended by personnel with no relevant training,
Medicare Advantage Plan users may be required to go through a pre-authorization process from the Plan before a coverage request may be approved. The treatment that is within the coverage is most likely the least expensive one.
LOOKING FOR ALTERNATIVES
These detriments may be enough to encourage a Medicare Advantage Plan user to seek alternatives. One option is to revert to the original plan and apply for supplements. There are several additions to the Original Medicare Plan that a user can explore to improve their plan. According to David Bynon from MedicareWire.com, there are actually seven ways to optimize your Medicare plan to fit all your needs and not having to pay for things that you are sure you won’t be needing in any way. Make sure to compare all your options and don’t rush into a decision. In a way, it’s creating your own plan and making it more custom to your needs, saving you money in the process.
An alternative for the Medicare Advantage Plan is Medigap. The goal of Medigap is to address the gaps between the different parts of the Original Medicare Plan. Medigap offers the user the option to cover some, or all, of the Medicare deductibles and coinsurances.
Like the Medicare Advantage Plan, Medigap is offered by private companies. Medigap also covers additional ground that the Original Medicare Plan does not cover, like access to medical care outside of the United States.
Here are some important things to keep in mind about Medigap.
- To qualify for Medigap, an enrollee to the Original Medicare Plan must have both Part A and Part B.
- The premium pay for Medigap is paid to the insurance company on top of the premium for Part B.
- Medigap covers only one person.
- A Medigap policy is guaranteed to be renewable even if a user has health problems.
- A Medigap policy can be bought from any insurance company that’s licensed to sell in any state.
- Medigap policies sold after January 1, 2006, are not allowed to include prescription drug coverage. Prescription drugs are covered by Medicare Prescription Drug Plan (Part D).
- Medigap policies generally cannot cover some services like:
- long-term care
- vision or dental care
- hearing aids
- private-duty nursing.
Another alternative is Medicaid. Medicaid is a government health insurance program. It is administered by the states, but it follows a set of federal rules. Those who qualify for Medicaid have low incomes while some have disabilities. A person does not have to be over 65 years old to qualify. The program is jointly funded by both the states and the federal government and the overall goal of Medicaid is to provide assistance to low-income Americans to receive health care.
At the end of the day, all of these insurance plans provide different advantages and disadvantages to people. In reality, the only way to get an in-depth understanding of the benefits of each of these plans is to talk to the medical assistance providers. Get to know the coverage, the limits and if you have any other option so you can avail of medical insurance.