For nearly 60 years, Medicare, a federal health insurance program in the United States, has provided coverage at a subsidized rate for seniors 65 and older. The Original Medicare program consists of two principal parts – Medicare Part A and Medicare Part B – offering hospital and medical insurance respectively.
With Original Medicare, however, you’re not covered for some key medical benefits that are critical for seniors. In addition, there are no annual limits for out-of-pocket expenses in Medicare Parts A and B.
Medicare Advantage Offers a Better Option
Legislation was passed 25 years ago allowing private health care providers to provide an alternative to Original Medicare with Medicare Advantage plans, also known as Medicare Part C or MA plans. Today nearly 42% of individuals who are eligible for Original Medicare are in a Medicare Advantage plan due to the broader coverage they obtain.
Premium Choice looks at how Medicare Advantage insurance provides you with more benefits than that of Original Medicare. Premium Choice is an online insurance agency that provides a one-stop marketplace for seniors to obtain Medicare Advantage and Medicare Supplement plans along with Life insurance.
How Medicare Advantage Plans Work
Medicare Advantage plans offer an alternative to Medicare Parts A and B coverage. Private insurers, approved by Medicare, offer Medicare Advantage plans in lieu of opting for the government’s Original Medicare program. Once insurance companies meet the Medicare minimum requirements for coverage, they can set their own premiums, benefits, and cost-sharing structures.
You will still have Medicare if you join a Medicare Advantage Plan, but you will receive the majority of your Part A and Part B coverage from your Medicare Advantage plan rather than from Original Medicare. Most Medicare Advantage plans also offer prescription drug coverage (what is known as Part D under Original Medicare).
Inside Medicare Advantage Plans
A Medicare Advantage Plan offers you the following key advantages:
Additional benefits than what’s available with Original Medicare
Premium Choice says that benefits include access to routine vision and dental, hearing, and health wellness programs, with the extent of coverage varying depending on the plan. These benefits are not available through Original Medicare, except under limited situations.
Lower out-of-pocket amounts on what you pay for hospital and medical expenses
Under Original Medicare Part A and Part B, as we mentioned, there is no out-of-pocket annual maximum, meaning you could end up spending significant money if you have a serious condition or illness. However, with Medicare Advantage plans, the Centers for Medicare and Medicaid Services (CMS) sets out-of-pocket spending limits, which for 2022 is $7,550. Once this limit is reached, you will pay nothing for medical services for the rest of the year.
Cost-sharing expenses could be less
Depending on the Medicare Advantage plan you choose, you may pay $10 for a visit to your primary care physician (PCP). With Original Medicare, you could have a coinsurance payment of 20% which would come to more than $10 per visit to your PCP. Also, copays and coinsurance are conveniently invoiced at the point of care with Medicare Advantage plans.
Coordinated care among your providers
Medicare Advantage plans are often managed care plans with networks of contracted health care providers. Health Maintenance Organization (HMO) Medicare Advantage plans are an example. You choose a PCP who will help you coordinate your care under these HMO plans.
Different plan options available
Insurance companies offer a selection of Medicare Advantage Plans – from an HMO to a Preferred Provider Organization (PPO) plan and other options. With a PPO plan, you can visit physicians in or out of the network. PPO plans allow you to use any Medicare-accepting provider.
Access to competitive plans
You’re able to shop around for well-priced plans from private insurers that are competing for clients and offer more flexibility in coverage benefits and pricing to fit your needs. Some plans come with a zero premium depending on where you live.
Premium Choice offers various Medicare Advantage plans from leading insurers, including AARP, Aetna, Anthem, Humana, and WellCare. We have more than 120 and counting licensed agent partners across the country who are ready to discuss these options with you.