If you’ve heard of Medicare Advantage, also known as Medicare Part C, you probably know that it includes all the services you get from Medicare Parts A and B. Knowing that, a savvy consumer will probably wonder what the difference is. Why should you pay for Medicare Supplements when you could obtain similar coverage for less with a private Medicare Advantage plan?
Medicare Advantage might work for you in several situations. When you’re thinking about your Medicare choices, ask yourself:
Do I need prescription drugs? If you take prescription medications, certain Medicare Advantage plans may be a more cost-effective choice. Medicare Parts A and B do not cover prescription medications; inorder to do that, you need a standalone plan called Part D, which does cover prescription drugs. However, most Medicare Advantage plans include Part D coverage. Like Medicare Advantage premiums, Part D premiums vary by plan. Extra help is available, so if you have a lower income and need drug coverage, Part D may still be the way to go.
Do I want vision, hearing, dental, or wellness plan services? If you want specialized care, you may want to consider Medicare Advantage. Perhaps you know you have frequent eye problems, or perhaps the state of your teeth is simply really important to you. While Original Medicare (Parts A and B) does not offer extra services like these, many Medicare Advantage plans do.
Do I want a cap on out-of-pocket expenditures? Original Medicare does not include an out-of-pocket spending maximum. This means that your copays or coinsurance can continue to add up with no limit. No one can predict the future, however, if in a year you require multiple Medicare services—frequent hospitalizations, or ongoing care that requires many doctors’ visits—you could end up paying quite a lot of money in out-of-pocket fees. A Medicare Advantage plan does include such a cap. Because private companies offer Medicare Advantage plans, CMS rules require an out-of-pocket limit for plans at $6,700. Some plans may offer even lower caps.
Do I like my Medigap options? There are two ways to supplement your Original Medicare coverage. Your first option would be to choose a Medicare Supplement Plan, also called Medigap, which helps with many of your Original Medicare deductibles and other expenses. Some people like Medigap plans because they offer complete freedom of choice, meaning no networks, no referrals, and no service area restrictions.
Would I rather have a copay or coinsurance? Original Medicare charges a 20 percent coinsurance for most services. But Medicare Advantage plans, many of which are HMOs or PPOs, structure costs differently. Like other HMOs or PPOs, they likely offer copays—fixed costs you pay for services.
Medicare shouldn’t be so complicated and difficult to understand—but it is. Who wants to spend hours and hours figuring this out, when you can have a 30-minute appointment and let an experienced HealthMarket agent do it for you! A HealthMarket agent does not push any particular policy and their services are free. They meet with you, determine your needs, explain in plain language what your options are, and take care of all the paperwork for you.
Call Pam Deaton of HealthMarkets to schedule a free consultation at 309-287-3518. HealthMarkets offers Medicare Advantage, Medicare Part D, and Medigap plans, and Pam knows how to help you choose the best option for your finances and your medical needs.Back to Top
September 09, 2022
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