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A Guide to Understanding Medicare Advantage Insurance

The principle behind Medicare Advantage is the convenience of getting all your medical care under one roof. It pulls together the costs and coverage of its various parts into a single plan. 

Today, we’ll review its most prominent features. Still, be sure to read more about Medicare Advantage when you’re ready to investigate further.

What Is MA?

Medicare contains four parts, A, B, C, and D, that cover various treatments and services. The first two comprise the Original Medicare Coverage, and D covers prescription drugs. 

Private health insurance companies approved by Medicare administer Medicare Advantage plans, also known as Medicare Part C. 

The law requires every Medicare Advantage plan to incorporate the coverage you’d get with parts A and B. Therefore, they include the same hospital and outpatient treatments, but they tend to come with additional perks.

Original Medicare vs. Medicare Advantage

Medicare Advantage plans are more convenient, combining medical and prescription coverage in a single system. 

Plus, some even offer dental and vision care. You can also get access to wellness coaching programs and multidisciplinary care management, all of which can help you lead a healthier lifestyle.

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Finally, it lets you predict out-of-pocket costs more accurately than the traditional plan. 

With Original Medicare, you pay up to 20% of most medical services costs under Part B. Medicare Advantage plans, on the other hand, have a fixed fee in most cases, with a maximum out-of-pocket cap.

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Supplement Plans vs. Medicare Advantage

Medigap, or Medicare Supplement plans, are optional extras. They help you pay for some of the out-of-pocket costs incurred with Original Medicare. However, Medigap no longer covers prescription drugs. 

However, if you have a Medicare Advantage plan, you can’t get (and don’t need) a Medigap policy.

Health Care Costs & Medicare Advantage

Costs are a crucial aspect of any healthcare plan. Let’s take a look at MA expenses.

  • Premiums – You’ll still have to pay a monthly Part B premium if you choose a Medicare Advantage plan, but the extra for Part C depends on the company.
  • Deductibles – Original Medicare has standard deductibles, while Medicare Advantage varies, with some companies charging zero.
  • Copayments – a set amount you have to pay for care is lower with MA. 

Plus, there’s a firm limit on how much you pay for care in a year. So, even if you fall severely ill and need a lot of treatment, the Medicare Advantage plan will cover the rest itself once you hit your yearly limit. 

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The costs of Medicare Advantage plans tend to be reasonable, thanks to networks of doctors contracted to the insurance companies. However, this also means that it won’t cover your care if you go outside the system, which brings us to the next significant consideration.

Plan Types

Note that you’ll still have to choose a healthcare plan type with Medicare Advantage. It can affect the benefits you receive and the costs you have to cover. You’ll most often run into two kinds, HMOs and PPOs.

With Health Maintenance Organization plans, you’ll usually need to use in-network medical professionals and get a referral to visit a specialist. Conversely, Preferred Provider Organizations grant you the flexibility to see providers outside your network and without a referral. However, this usually costs more.

What About Travelling?

If you travel a lot, it can be tricky to use MA plans. They tend to have defined service areas, restricting the available healthcare professional network. 

However, you can obtain a policy that works in more areas if you look hard enough. It pays to find a system that covers you all year long and wherever you are.

Medicare Advantage: Pros and Cons

Let’s finish by reviewing the benefits and drawbacks of this plan type to underline its most prominent characteristics. 

MA Pros

In general, the most significant selling point of Medicare Advantage is that it covers more benefits than Original Medicare. 

So, you get treatment included in Parts A and B, plus the added benefits of routine vision and hearing checkups, dental care, and prescription drugs. It also costs you less, even with the Medicare Advantage premium charge.

Moreover, although you can’t choose all your doctors, you can access a certified medical expert network, making healthcare more manageable and convenient. 

MA Cons

Even with the benefits we mentioned, many people opt out of Medicare Advantage plans. 

It tends to happen because the plan limits your freedom of health care provider choice, which Original Medicare doesn’t do. It also requires referrals and authorizations before it covers your costs, which could inconvenience you.

Finally, the service areas included in MA plans are quite limiting if you travel a lot. 

The Bottom Line

Overall, while MA smoothly puts together the benefits of other Medicare parts and sprinkles extra services on top, it’s not for everybody. There’s the trade-off between comfort and affordability. 

It’s the best for people who live a settled lifestyle and need to budget their healthcare. If you’re unsure, take a look at various insurance companies’ offers and try to apply them to your situation before you make a purchase.