There are valid reasons that more than one-third of the people who are eligible for Medicare choose to upgrade to Medicare Advantage as stated by Medicareusa.com. For the two-thirds of the people who don’t upgrade to Medicare Advantage, it’s sometimes a matter of them not understanding their options.
If you are currently paying monthly premiums related to traditional Medicare insurance, your coverage is limited to hospitalization (Plan A) and basic medical costs (Plan B). If you would like to have a more comprehensive Medicare option, Medicare Advantage might be the way to go. To help you make the right decision, the following information will focus on the nuances and additional healthcare insurance benefits that come with Medicare Advantage.
What Is Medicare Advantage
Traditional or original Medicare insurance is often referred to as the “Plan A” option even though it does include Plan B coverage. According to the Medicare.gov, Plan A includes “inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.” For a lot of Americans, a traditional Medicare doesn’t provide the level of insurance coverage they want/need. In such cases, Medicare Advantage warrants consideration as the next upgrade option.
The healthcare insurance industry often refers to Medicare Advantage plans as “Part C” or “MA Plans.” While traditional Medicare programs are administered by the U.S. government, Medicare Advantage programs are managed by private insurance companies.
What separates Medicare Advantage from the original option is the possible inclusion of other healthcare services like:
- Dental care
- Ears, throat, and nose care
- Prescription drug coverage (known as Plan D services)
- Vision care
- Fitness services (gym memberships, etc.)
It’s noteworthy that not all U.S. residents who are eligible for Medicare will also be eligible to obtain Medicare Advantage. There are currently more than 75 U.S. counties where Medicare Advantage plans are not available.
How You Would Cover The Costs Of Medicare Advantage
If you are currently paying for an Original Medicare plan, you are likely doing so in one of two ways.
First, you might be sending your Medicare payments directly to the government agency that is administering your plan. Second, you might be among the tens of millions of Americans who are having their Medicare premiums deducted directly from their Social Security benefits.
If you fall under the latter category, you should be aware that the monthly amount being withheld is being sent to your Medicare plan administrators through the Social Security Administration. For what it’s worth, the standard monthly Medicare deduction for U.S. citizens receiving SS benefits is approximately $120 a month.
If you were to decide to go with a Medicare Advantage plan, you would need to continue making your payments to the U.S. government. On your behalf, the U.S. government Medicare administrator would then forward those payments to the Medicare Advantage provider of your choice. Those payments would represent payments against a portion of the monthly premiums you owe to your private provider. It would then be incumbent on you to pay the remaining portion of your monthly premium directly to the provider.
The amount of additional premium would depend on several factors, including:
- Your state and county of residence
- The additional coverage you want to be included in your plan
- Whether you choose a HMO or PPO option
More About Drug Coverage In Medicare Advantage Plans
For a lot of seniors, prescription medications are necessary for the treatment of medical conditions. As such, seniors are often very sensitive to the amount they will need to pay each month out of pocket for their medications.
The good news is many Medicare Advantage plans include prescription drug coverage (Part D). If are considering a Medicare Advantage plan that doesn’t offer Plan D, you do have the right to purchase a separate Plan D policy from a private insurance company.
If you do decide to purchase a separate Plan D policy, you would automatically be disenrolled from your Medicare Advantage Plan, and subsequently returned to a traditional Medicare plan. That would leave you with Plan A and Plan B coverage through your original Medicare plan, plus your private Plan D policy. The only coverage you would not have is for the additional services mentioned above.
To be clear, people who are eligible for Medicare are allowed to opt-out. If you were to decide to go that route, it would be incumbent on you to purchase your own private healthcare insurance policy. Failure to do so would be in violation of the Affordable Care Act, though the penalty for adhering to the law has been removed.
Hopefully, this information has clarified any questions or concerns you have about Medicare (original) and Medicare Advantage. If you are interested in a Medicare Advantage option, you should consult with a local insurance agent.