Why choose Medicare Advantage over original Medicare?

Medicare insurance

When relying solely on original Medicare, seniors can incur significant out-of-pocket costs after seeing a doctor or staying at the hospital. This is why many Medicare beneficiaries choose Medicare Advantage plans in order to improve their health care coverage. Medicare Advantage plans are a smart choice in 2017 as they replace original Medicare Part A and B benefits with usually better coverage by a private insurer. Most seniors prefer such a Medicare advantage over Medicare, because they offer more coverage and additional benefits with less out of pocket expenses.

Why Choose Medicare Advantage?

There are two key factors why members like their advantage plans. First of all, advantage plans offer ‘guaranteed acceptance’, which means the plan will accept you, even if you have a pre-existing health problem (with the exception of End Stage Renal Disease). Second, they are affordable. Some plans even have $0 premium over your Part B premium, for others you have to pay additional premiums, co-insurance or co-pay – it depends on the plan and its benefits.

How Do Medicare Advantage Plans Work?

While traditional Medicare is administered by the government, advantage plans are offered by private health insurance companies. Each insurer can set own rules for the Medicare Advantage plans offered, but all must abide by federal government guidelines as the plans are subsidized. Medicare advantage plans are rated on a five star scale. Plans with higher rating will receive more federal subsidies – helping insurers to keep their premiums low, and add extra benefits to their plans to make them even more attractive.

You may sign up for HMO, PPO or a Fee For Service (FFS) plans. The majority are health maintenance organizations (HMO) plans. With HMO plans, you typically have to use a network of healthcare providers and see your primary care physician for a referral in order to consult with a specialist. Non-emergency care by a health care provider outside of that network is not, or only partially covered. Thus it is very important that you check the plan’s list of providers to find out whether your current doctor will accept the plan.

Medicare Advantage Plan Benefits

Medicare advantage plans pay for your Part A and Part B Medicare costs, and often include co-pays for services that are only partially covered by Medicare, plus additional coverage for services not covered by Medicare, such as prescription drugs, dental, eyeglasses or hearing aids. Some even pay for health club memberships. Which drugs are covered depends on the plan’s ‘formulary’, so make sure to check whether or not the medicine you need is included, before you select a plan.

Am I Eligible And How To Enroll In A Medicare Advantage Plan?

Depending on where you live, you will have dozens of plans to choose from. In rural areas however, there will be less plans available. You can enroll in an advantage plan if the plan accepts new members, you live in the plan’s area, and you have Medicare Part A and Part B and don’t have End Stage Renal Disease.

You may first enroll when you become eligible for Medicare, usually at your 65th birthday (or earlier, if you are disabled and on Social Security). After that, you can only enroll in a Medicare advantage plan at a specific time each year, the Open Enrollment period. A Special Election Period (SEP) allows Medicare beneficiaries at any time to enroll in a 5-star Medicare Advantage plan (some rules apply).

Thanks to the internet, it is more and more easy to compare benefits and to get quotes for Medicare advantage plans online. You may find Medicare advantage plans for 2017 that are available in your local area either with the help of a licensed health insurance broker, by contacting the insurance company itself, or visiting the official government website at medicare.gov.

By: Joseph Rosario

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