Why Do Some Seniors Choose Medicare Advantage?

Some seniors choose Medicare Advantage for the coverage. Some choose it for the out-of-pocket maximum. Others choose it for affordability. Whatever your reason for enrolling in a Medicare Advantage plan, Carolina Senior Benefits is here to help.

Medicare Advantage

Medicare Advantage plans are in many cases a chance for Medicare beneficiaries to save money in out-of-pocket costs toward their Medicare coverage. These plans can have low or no premiums and offer additional benefits that Original Medicare likely never will. As an affordable alternative, Medicare Advantage plans offer a great many benefits.

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans. 

  • Health Maintenance Organization (HMO) Plans  
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

Medicare Advantage Benefits

Medicare Advantage plans can bring seniors several advantages over Original Medicare. These plans all have out-of-pocket maximum limits. While Original Medicare, which has no out-of-pocket limit, uses benefit periods that can charge you multiple Part A deductibles over the year, Medicare Advantage plans serve to cap that spending for you.

Medicare Advantage plans also are able to offer you coverage that Medicare does not, including coverage for routine dental, hearing, and vision care and prescription drugs. You can purchase these benefit packages for additional premiums. Adding these packages increases the convenience factor as well because you will be using the same insurance provider for all of your health insurance coverage instead of having to purchase a separate supplemental insurance plan.

Medicare Advantage Coverage

Medicare Advantage plans cover the same services that Original Medicare covers under Medicare Part A and Part B. Medicare compensates these companies for handling your coverage.

Most Medicare Advantage plans contract with networks of health care providers to bring you low negotiated rates for covered services. These networks use providers within the plan’s coverage area. 

One type of Medicare Advantage plan, called Special Needs Plans, is tailored specifically to its members. These plans come in three types: Chronic Condition, Dual Eligible, and Institutional. People with Chronic Condition Special Needs Plans to have access to a network of health care providers, including specialists, who are able to treat their condition. Dual Eligible Special Needs Plan members are able to receive care from a network of providers who accept Medicaid, which is important for them to afford their care. Institutional Special Needs Plans to cater to the needs of people who live in an institution.

Why Choose Medicare Advantage?

Medicare Advantage plans are a great option for seniors looking to expand their Medicare coverage. These plans give you access to networks of providers and services at negotiated rates, as well as the coverage you can’t find under Original Medicare.

Can You Have Medigap and Medicare Advantage Together?

You cannot have Medigap and Medicare Advantage at the same time. Private insurers cannot offer Part C coverage if you are currently enrolled in a Medicare Supplement, as it would be illegal to do so. It is an either-or situation when it comes to Medigap and Medicare Advantage plans. Once you are enrolled in Original Medicare, you can choose to add on a Medigap plan or join a Medicare Advantage plan. Medigap plans were only designed to supplement Original Medicare, whereas Medicare Advantage is more of an alternative to Original Medicare.