These days, tens of thousands of seniors are choosing Medicare Advantage plans, also known as Medicare Part C, to cover their health expenses. Offered by private insurers, these plans often have lower premiums and offer more benefits than traditional Medicare. Medicare Advantage combines Original Medicare — Parts A and B that cover inpatient care and outpatient care — with other benefits, such as dental, hearing, vision, and fitness. It also integrates drug prescription coverage.
Over the past decade, Medicare Advantage plans have grown in popularity among seniors. More than 28 million elders enrolled in a Medicare Advantage plan this year, which accounts for 48% of the eligible Medicare population. Extended benefits and limits on out-of-pocket costs are two reasons seniors opt for these plans.
Most Medicare Advantage plans are HMOs, short for health maintenance organizations, while PPOs, or preferred provider organizations, are the second most preferred plan. Other private plans include private fee-for-service (PFFS), special needs plans (SNPs), Medical savings accounts (MSAs), and HMO point-of-service (HMO-POS).
HMOs vs. PPOs
HMOs offer care within a defined network of doctors and hospitals and are more commonly referred to as in-network providers. You can only choose network providers for covered services; a referral is required for specialist care. You will have to pay the entire bill if you consult an out-of-network provider but will owe considerably less with in-network claims.
PPOs, on the other hand, allow you to seek care from a service provider outside the network at regular rates, as it also offers coverage for out-of-network care. You can also consult a specialist without a referral.
You enjoy a lot of benefits when you pick a Medicare Advantage plan. But, like most Medicare plans, this private plan has its share of disadvantages. You need to be aware of both the pros and cons of choosing the best plan for your healthcare needs.
The Pros of Medicare Advantage Plans
Offers Benefits Not Covered By Original Medicare
Medical Advantage plans offer benefits usually not covered by Original Medicare, Parts A and B. These include routine dental care, vision care (contact lenses and glasses), hearing care, and wellness programs.
Includes All Coverage in One Convenient Plan
Medicare Advantage encompasses hospital and medical insurance in one convenient, low-cost plan.
Proffers Low or No Monthly Costs
Unlike Original Medicare, which this year requires beneficiaries to pay monthly Plan B premiums of $170.10, Medicare Advantage plans typically don’t have monthly premiums. If they do, it tends to be rather expensive.
Cons of Medicare Advantage Plan
Limited Network of Service Providers
You get care from a limited network of healthcare service providers and cannot consult a specialist without a prior referral.
Denial of Necessary Medical Care
Federal investigators have found that people enrolled in Medicare Advantage plans are sometimes denied necessary medical care covered under the private program.
Difficult to Get Care in Rural Areas
Rural areas lack a comprehensive network of service providers, making it hard for people to get care under the plan.
Take Advantage of Medicare Open Enrollment
With open enrollment in Medicare currently underway, you can switch, add, or drop a plan. Make sure to find out about the best Medicare Advantage plans and then switch to the one that best meets your healthcare needs. This period ends on December 7.
