What is Medicare Advantage?
Every person has different healthcare needs. For that reason, you can find various health insurance policies on the market. They are available in different forms and cater to different ages. As you age, your healthcare needs increase. That’s why the federal government designed Medicare plans for seniors above 65. With so many options available, it can be difficult to shop for the right plan. It will not be easy as you will be bombarded with a myriad of options.
When finding the right healthcare coverage, it is vital to consider the plan’s affordability, healthcare providers and facilities you can visit during emergencies and the quality of care you can get. You should also take into account whether or not you need medical aid when you travel. And if you are taking prescription medicines, you must consider this factor as well in finding the right policy.
As you shop for the right coverage, you will stumble upon Medicare Advantage plans. You may wonder what they are and how they offer coverage. Medicare Advantage is Part C Medicare. Compared to Part A and B, it is more extensive. You cannot obtain the plans from Medicare. Rather, you can get it from private insurers, which are licensed to sell them. Medicare still oversees and controls these plans, though. The goal of this post is to help you better understand this type of Medicare program. After reading, we hope that you will have an easier time making the right decision.
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Understanding How Original Medicare Works
Original Medicare is a type of health insurance that protects seniors over 65 years. If you have not reached that age yet but you are suffering from permanent kidney failure, then you are eligible for it. Individuals who receive disability insurance are also qualified to obtain Initial Medicare even though they are not yet 65.
Medicare is funded through the Federal Insurance Contribution Act. Each taxpayer pays around 1.45% from their income to such Act. Your employer matches your payment. For that reason, Medicare Part A is free for people who work for the past 10 years. However, if you have been working for less than a decade, you will need to pay a premium.
Part A of Medicare includes inpatient hospital costs, services of a skilled nursing provider and home care. It also covers hospice care. But Part A does not cover private rooms. It does during a certain condition or if your health condition requires it.
Original Medicare includes Part A and B. Part A, as mentioned earlier, is paid free. But Part B is not. You will have to pay for its premium. This protection includes medical insurance, doctor’s visits, lab tests, flu shots, and outpatient services, as well as x-rays. It also includes medical equipment, like crutches and walkers. But Original Medicare does not include Part D, which is a prescription drug plan. If you need it, though, you will have to purchase it separately.
How Medicare Advantage Works
Medicare Advantage is also known as part C plan. It is also sold by private insurers but they are licensed by the federal government. This plan is also controlled and regulated by Medicare.
All MA plans have basic plans. Furthermore, each plan has Part A and B coverage. For that reason, you cannot purchase an MA plan if you do not have an active Original Medicare.
When you have an MA plan, you need to pay its premium, plus Part B’s premium. Some people are qualified to obtain an MA without reaching a certain age. You may talk to our health insurance experts to know about it.
MA plans have different network options. One of them is the Health Maintenance Organization (HMO). This network option lets you access healthcare only from within the network. Among the many network options, HMO is the most affordable.
The other popular option is the Preferred Provider Organization (PPO). Here, you can visit any healthcare provider. However, you will pay more if you receive treatment outside your plan’s network and pay less if you obtain it within the network.
Another option is Special Need (SNP). But it is only accessible by a few individuals. For instance, if you have a chronic condition or if you live in a nursing home, then you may qualify for this option.
MA plan has a Private Fee for Service (PFFS) option. It works like Original Medicare. That is, your insurer will decide the services you need should cot and pay a portion of the amount.
The last option is Medicare Savings Account (MSA). Here, it mixes deductibles with a bank account. Your provider will deposit a certain amount. You can use it for your health services within a year.
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Original Medicare vs Medicare Advantage
Compared to Medicare Advantage, Original Medicare excludes out of pocket maximum. The lack of such maximum means that there is no way to tell when you will find relief from paying coinsurance, deductibles, and copayments.
But MA plans have maximum. When you reach that amount, your insurer will start paying for your medical care.
Furthermore, if you use Medicare, you will get Medigap or obtain Part D separately to gain access to prescription medicines. MA has extensive packages that can include prescription drugs on their own. MA plan can also include conditions that Medicare will not cover.
When you reach a certain age, you are automatically qualified for Part A. You just need to apply for Medicare Part A. Then, if you think you need more coverage, you may consider Medicare Advantage. When you choose an MA, you must know that the benefits will change with time. You should also keep yourself updated on the new details regarding your plan.
Do You Need Medicare Advantage Plan
If you have Original Medicare, you may find that it is not enough to help you pay for your healthcare costs. Thus, if you have certain medical conditions, you should consider getting a Medicare Advantage plan. It may cost you more for premiums. However, it is worth it considering the extensive coverage that it offers. Then again, it is ideal that you study all your options before you purchase one.