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Is Medicare Advantage Coverage As Good As Original Medicare?
The common misconception here is that you lose coverage or end up with a reduced amount of health coverage when you choose a Medicare Advantage health plan. This idea is just simply not true. In fact, the opposite is actually true.
In the majority of cases, Medicare Advantage plans offer more coverage than original Medicare. When Medicare Advantage was set up, one of the requirements was that the plans had to provide at least the same amount of coverage as original Medicare, and the requirement still holds true today.
The additional coverage comes in many cases in the form of preventative care for things that Original Medicare does not cover such as dental, vision, and even in some cases hearing aids. Some Medicare Advantage plans are even offering trips to the doctor’s office and pharmacy, the ability to order over the counter items such as vitamins, and even the popular Silver Sneakers program!
Can I Keep Seeing My Doctor With Medicare Advantage?
This is where you need to do your research. In most cases, you are able to continue seeing your favorite doctor with Medicare Advantage. First, you need to look at the type of network that the Medicare Advantage health plan is offering. The types of networks vary by PPO, HMO or PFFS as the primary types. Look at each one to see how it might fit your needs.
An HMO will require that your doctor be in the plan’s network. This is simple enough. All plans have a provider directory that you will be able to use to look up your doctor. Hint: if you use the online directory you are more likely to have accurate results. This is where you may sometimes run into your doctor not being in the plan’s network, but not always.
Some HMO’s have huge networks, while other HMO’s have smaller networks. If you do decide to go with an HMO, make sure that every provider and facility that you want to use is in the plan’s network.
A PPO does not require that your doctor be in the plan’s network. In fact, most PPOs will even say in their documentation that you may see any provider that you want to see. A Medicare Advantage plan PPO will have a provider directory just like the HMO, but the difference is that you will still be able to see your doctor even if he is not listed in the directory.
Note: There are two things to consider here. First, your doctor will still need to be willing to file the insurance which a lot of them do; and second, you will have higher out of pocket cost when seeing a provider outside of the plan’s network. If you decide to go with a PPO, it’s a good idea to find one where the majority of your providers are listed in the plan’s network.
A PFFS is the less common type of network that is fairly unique in it’s setup. The PFFS will likely have a network as well, but it also offers the ability to see doctors outside of the network without paying additional costs. The key here is that the doctor has to be willing to accept the plan’s terms and conditions for payment at the time of the visit.
Basically, it means that the provider may choose at any time to accept the insurance or not. Typically, if the provider takes it once they will continue to unless there is some issue with payment from the PFFS.
How Much Will I Pay Using A Medicare Advantage Health plan?
You can usually save lots of money by choosing to enroll into a Medicare Advantage plan. The reason is that many Medicare Advantage Health plans offer coverage with a $0 plan premium. This means that you are not having to pay large monthly premiums, and offers you the opportunity for great savings. Some plans even pay you to enroll with them!
As crazy as that sounds it is absolutely true. They call it a Part B buyback and they will reduce what you have to pay for your Part B of Medicare. Sometimes it is just a portion of it, and in some cases they pay the whole thing. The bottom line is that it ends up putting more money into your pocket at the end of every month.
Since many Medicare Advantage plans cover routine care at a $0 cost, you could end up going to your annual doctor’s visit, having your eyes checked, doing your routine screenings, and end up literally paying nothing for the year in health care costs. If you do end up sick or having procedures performed, there are generally low co-pays that you will have to pay at that time.
Why Should I Join a Medicare Advantage Health Plan?
There are many reasons to join a Medicare Advantage plan. Besides saving money on a monthly basis, you are also provided with the protection of a Maximum Out of Pocket. Original Medicare does not offer a MOOP or Maximum Out of Pocket.
This means that if you went into the hospital with Original Medicare and had a major surgery done, you could easily end up on the wrong side of a $100,000 hospital bill. This will not happen when you are enrolled into a Medicare Advantage plan. The Maximum Out of Pocket caps the amount of cost that you are responsible for if the worst case scenario happens to you. Many times these MOOP’s are under $5,000 and most of the time under $10,000.
Is Medicare Advantage Still Medicare?
When you join a Medicare Advantage plan, you absolutely do NOT lose your Medicare coverage. In fact, in the Medicare and You handbook, Medicare Advantage is referred to as Medicare Part C. When you think of Medicare Part C, think of C = Complete.
It combines your Part A, Part B, and Part D benefits into one nice convenient insurance coverage. You do receive a new insurance card from the company that you join which you must use like any other typical insurance when visiting the doctor. The confusion comes in because you are no longer showing your Medicare card at the doctor’s office. You still have Medicare!
What happens is that your Medicare Advantage insurance company is paying your bills now instead of Medicare. Medicare in turn pays the Medicare Advantage company every month to handle your medical bills. The bottom line is that joining a Medicare Advantage health plan does not kick you out of Medicare, but instead typically enhances your Medicare coverage.