Medicare, the federal health insurance company based in the United States, provides extensive health care plans to lower health bills.
The US federal government administers Medicare, and the General Revenue and Federal Insurance Contributions Act tax funds it.
Medicare provides coverage for prescription drugs, hospital bills, medical equipment, et cetera for older adults aged 65 or above, people with disabilities, and people with last-stage renal diseases.
This health insurance company features various medical social insurance programs such as Original Medicare (part A and B), Premium Medicare, and Medicare Advantage plans (MA).
Medicare Advantage plans are private health insurance plans that cover everything as the Original Medicare with additional benefits.
Let us delve into this comprehensive guide to navigate through the complexities of Medicare Advantage, also called Medicare Part C, to make informed healthcare decisions.
What Is Original Medicare?
Original Medicare is a health insurance program comprising two parts, Parts A and B, respectively.
Medicare Part A covers basic hospital insurance such as billing for medicines and drugs, hospital meals, semi-private rooms, and skilled nursing services.
Part A insurance also covers your stay in mental hospitals and skilled nursing facilities.
Original Medicare Part B covers outpatient care, doctor’s visits, home health services, physician services, preventive services, and access to medicines and medical equipment.
Eligibility Criteria for Medicare Plans
Qualification Age: Older adults aged 65 and above qualify for Medicare plans.
Other Qualifications: People under the age of 65 with certain disabilities, chronic conditions, end-stage renal disease, or Amyotrophic Lateral Sclerosis can qualify for Medicare plans.
What Is A Medicare Advantage Plan?
Medicare Advantage plans, also popularly called Part C plans, are private health insurance plans that collaborate with Medicare. Enrolling yourself in a Medicare Advantage plan means that your Medicare coverage for health services will be processed by a private plan of your choice.
Private healthcare insurance companies offer these Medicare Advantage plans. These plans cover Part A (hospital insurance) and Part B (medical insurance) with the addition of Part D (drug coverage).
Besides these, a Medicare Advantage plan also provides hearing, vision, and dental coverage. Thus, the Medicare Advantage plan is a comprehensive private healthcare insurance option by which you receive the benefits of original Medicare with the addition of other services.
What Specific Services Are Included in the Medicare Advantage Plan?
Besides Part A (hospital services) and Part B (medical services), the Medicare Advantage plan covers the following.
- Eyeglasses for vision
- Hearing aids
- Dental care
- Fitness programs
- Health services
- Transportation services (required for a medical purpose)
What Are The Different Types Of Medicare Advantage Plans?
There are five types of Medicare Advantage plans.
Health Maintenance Organizations (HMOs)
In-network provider, typically called an HMO provider, is an approved healthcare expert within the plan’s network.
In this plan, care is received from a doctor, healthcare provider, or hospital within the network of your chosen plan. In emergencies or urgent situations, you require a referral from your primary healthcare provider to consult another specialist.
Preferred Provider Organizations (PPOs)
PPOs allow you to receive medical care from an out-of-network provider, but they typically cost more.
Also, you’re not obligated to use your primary care doctor, but you incur relatively lower costs for medical experts and hospitals within the plan’s network.
Special Needs Plans (SNPs)
SNPs are dedicated healthcare programs for providing specialized healthcare to individuals with chronic conditions, individuals living in nursing homes, and those who have both Medicaid and Medicare.
Private Fee-For-Service Plans (PFFS)
In PFFS, you aren’t obligated to go to a specific healthcare expert within the plan’s network. PFFS plans work like Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions.
This plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive.
Medical Savings Accounts (MSAs)
A high-deductible health plan like MSA requires you to pay an out-of-pocket amount before the healthcare insurance coverage provides any benefits. A savings account is linked to this plan.
Medicare adds money to your healthcare savings account each year, which you can spend on your healthcare services. However, these plans lack coverage for prescription drugs and medicines.
What Is The Cost Of The Medicare Advantage Plan?
The monthly out-of-pocket amount that you pay for a Medicare Advantage plan is called the premium. In 2024, the estimated cost of the monthly medicare advantage plan is $18.5.
Medicare costs fluctuate according to the level of coverage, which means that you may even pay as low as $0 to as high as $505. Also, you should be well informed about your enrollments.
Before you can access a Medicare Advantage plan, you must already be enrolled in Medicare Part B. Therefore, you must pay a Part B premium even if enrolling in a Medicare Advantage plan. The estimated Part B premium is $174.70 per month.
Benefits Of Medicare
From annual medicare deductibles and healthcare services to preventive care, Medicare offers many perks. Medicare Part B covers your yearly wellness visit to an approved doctor. It also covers flu shots and screenings for CVS diseases or diabetes.
These services are a part of your Medicare Advantage plan as well as you’re already paying the premium for Medicare Part B.
Such services help monitor your overall health over the year. Early diagnosis of multiple diseases is crucial in preventing chronic conditions.
Thus, you can make smarter health decisions while also preventing yourself from long-term payments of persistent health problems.
How Do You Enroll in Medicare?
If you wish to apply for Medicare, you can do it online or by mail. If you’d like to have a walk-in option, you can apply at a Social Security office. There are Medicare enrollment periods during which you can sign up.
Private Medicare plans have a limited enrollment period. When you join Medicare, there is an initial enrollment period (IEP) during which you select your medicare advantage plan.
The medicare advantage open enrollment period is from January 1st until March 31st. During this period, you can also switch your healthcare plans to disenroll from one to return to the Original Medicare access.
Make Informed Decisions With Silver Edge Advisors: A Key Takeaway
Before you enroll yourself in a Medicare plan, you must familiarize yourself with all the available healthcare plans to make an informed decision. Exploring your options to decide the right healthcare coverage for yourself or a loved one may seem daunting.
Through expertly chosen medicare decisions and customized plans, you and your loved ones can navigate through Medicare with confidence!
With Silveredge expertise and unwavering support through a team of licensed insurance agents, you can evaluate health insurance coverage, get an answer to your questions, and openly discuss your healthcare insurance options.