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Medicare Advantage plans are part of Medicare but offered by private insurance providers. It is also referred to as Medicare Part C. The private insurance providers for such plans are approved by Medicare.
The good thing about opting for Medicare Advantage is that you can get coverage included in Medicare A and B (original Medicare plans) in addition to other benefits. Some Medicare Advantage plans also include coverage for prescription drugs and most often you won’t need to pay any additional premium on it too.
Some examples of extra benefits can include routine hearing, vision or dental checkups. Depending on your state, you can also get benefits such as fitness memberships, monthly allowances or perks for OTC items, and more.
The benefits offered by Medicare Advantage plans can differ from one state to another. For instance, Medicare Advantage plans in Texas may offer certain extra benefits that you may not find in another state.
There are different kinds of Medicare Advantage plans similar to the original Medicare.
HMOs or Health Maintenance Organization require you to use only the providers in their network and you will need referral from your primary care doctor to see them. PPOs or Preferred Provider Organization offer more flexibility than HMOs. You don’t need any referrals to see other specialists. You can even enjoy more coverage benefits by opting for doctors in the network. PFFS or Private Fee-for-Services are plans where the costs are shared. You will need to pay certain amounts while your plan will pay the rest of the costs.
Then there are certain other plans such as SNP or Special Needs Plan, which are customized to offer specific benefits depending on your medical conditions. MSA or Medical Savings Account is a plan that deposits money into your account, which you can utilize to pay for your medical expenses or healthcare costs.
Your insurance advisor can help you understand the different plans and recommend the right one for your needs.
To be eligible for Medicare Advantage, you need to first enroll in the original Medicare plans. You also need to live in the service area of the plan. But despite accounting for these eligibility criteria, you won’t be able to qualify for a Medicare Advantage plan if you have end-stage renal disease (ESRD).
But in certain special cases, you can get Medicare Advantage even with ESRD. For example, if you are already enrolled in a Medicare Advantage plan before developing ESRD, there is a chance that you might be able to continue with it. If the organization offering your employer health plan or any other plan is the same one providing your Medicare Advantage then also it is a possibility to continue with the latter even with ESRD. If you have ESRD but have had a kidney transplant, you may be able to qualify for Medicare Advantage if you also qualify for other Medicare benefits.
You can opt for Medicare Advantage plan once a year during the Annual Enrollment Period. You also have the option to sign up for it during the Initial Enrollment Period.
You can even opt out of your Medicare Advantage plan by choosing another plan. You can even switch to only original Medicare plans by contacting the concerning agency in your state. Your insurance advisor can also help you in this regard. You can work with a reputed insurance agency in your area to choose the best Medicare Advantage plan for you.
Like other Medicare plans, the Medicare Advantage plans also include different cost-sharing options such as copayments and co-insurance. You will also need to pay the deductible amount before your Medicare Advantage benefits will start. But the cost benefits will apply to everything that your plan will cover.
One big benefit of Medicare Advantage plan is that you don’t have to pay any amount beyond your out-of-pocket maximum. It is unlike other Medicare plans where you pay a percentage of the total costs. The latter option can be disadvantageous for you if the bill for a medical expense is quite large. Before enrolling for original Medicare, it can be helpful for you to know about the benefits offered by Medicare Advantage plans in your state.