Original Medicare (Parts A and B) work together to provide you with basic healthcare coverage after turning 65. But, there are common healthcare costs that Original Medicare does not cover. Medicare Advantage policies, also known as Medicare Part C, are an “all in one” alternative to Original Medicare, that often offers many additional benefits, including prescription drug coverage (Medicare Part D).
Let’s look at an alternative to Original Medicare, Medicare Advantage/Medicare Part C.
WHAT IS MEDICARE ADVANTAGE?
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The federal government only administers original Medicare benefits. Medicare Advantage plans are a private insurance alternative to receiving your Medicare Benefits. These policies provide you with all benefits you receive from Medicare Parts A & B -and many other benefits not covered by Original Medicare- bundled into one plan.
If you join a Medicare Advantage Plan, you’ll have all of the same rights and protections that you would have under Original Medicare. You’ll still have Medicare but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.
So, what are the differences between Medicare and Medicare Advantage plans?
See Your Same Doctors!
It’s important to feel confident about the healthcare you receive! Transitioning to Medicare doesn’t have to mean new doctors. When shopping for Medicare Advantage plans, don’t forget to make sure your doctors are in the network.
MEDICARE ADVANTAGE ELIGIBILITY
- You are qualified/enrolled in Medicare Part A and Part B
- You’re a US citizen
- You live in the plan’s service area
Location Matters
Medicare Advantage plans are administered by independent insurance companies, so there may be limits to where some plans can be bought. Like health coverage you may have held in the past, Medicare Advantage plans also have local and national networks of preferred health providers.
Regional Network Medical Coverage
Make the most of your benefits by visiting providers that are in your plan’s network. Visiting in-network providers, you will pay less out of your own pocket than if you visit providers who don’t have a contract with your insurer.
WHAT DOES MEDICARE ADVANTAGE COVER?
All Medicare Advantage companies are required to offer complete Part A and Part B coverage. But because Medicare Advantage plans are provided by different insurance companies, each plan may offer different types of additional coverage options. Most Medicare Advantage plans carry additional benefits such as:
- Lower copayments and out of pocket costs
- Prescription Drug Coverage: Medicare Part D
- Dental coverage
- Routine eye exams
- Hearing Aids
- Long Term Nursing Care
Be sure to compare benefits, costs, and networks to determine the right plan for you.
WHAT DOES MEDICARE ADVANTAGE COVERAGE LOOK LIKE?
Medicare Advantage plans have an out-of-pocket maximum each year. Once you hit a certain dollar amount, your plan pays 100% of the cost for most services it covers.
Full Medicare Benefits + Additional Coverage on one inclusive policy.
You will still receive all of your Part A and Part B coverage, but with additional healthcare benefits. Here are some examples of additional benefits you may find are covered with a Medicare Advantage Policy :
- Prescription Drug Coverage
- Annual eye exams and glasses
- Dental work
WHAT ISN’T COVERED?
Each Medicare Advantage policy offers different benefits options and exclusions, so it’s important to understand your policy options. Be sure to work with a trusted advisor to find the best Medicare Advantage Plans for your needs.
There are certain drugs that Medicare does not cover. Each Part B plan offers different benefits options and exclusions. When you understand your options, it’s easier to choose with confidence!
Though plans may differ, Generally, Medicare will not provide coverage for medications prescribed for:
We’re Here to Help!
Part D prescription drug coverage depends on each insurance company and each plan. Schedule an appointment with one of our advisors today to fund the best rated Medicare Part D plans for you.
MEDICARE ADVANTAGE PREMIUMS AND COSTS
Monthly premium costs for Medicare Advantage policies may differ across plan options.
-Many policies offer low and $0 monthly premiums for coverage.
Medicare Part B Premium
-You still pay for your Part B premiums, though some Medicare Advantage plans may help with that cost.
ADDITIONAL COSTS AND CONSIDERATIONS
Medicare Advantage plans may offer benefits that help keep your out-of-pocket prices low. With most Medicare Advantage plans, typical costs may include copayments for office visits.
You’ll also be subject to an annual deductible. After your deductible has been met you’ll have to pay 20 percent of the cost for doctor visits and other outpatient services.
Click here for an infographic/video explaining the calculation of costs
I.e
DEDUCTIBLE + COINSURANCE+COPAYS= TOTAL ANNUAL COST