If you are currently looking for a healthcare cover, you might be wondering which option between Original Medicare and Medicare Advantage Plan you should get. There is not a simple answer considering that Medicare Advantage plans come with essential features that most people find attractive or beneficial and other characteristics that do not necessarily match their lifestyle or personal preferences. For more information on supplement plans visit Medisupps.com.
Let us take an even closer look at some of the key pros and cons of taking up Medicare Advantage Plans.
Medicare Advantage Plans Pros
Medicare Advantage Plans Generally Offer More Benefits Than the Original Medicare
A Medicare Advantage plan should offer, at the very least, the same amount/level of coverage as the Original Medicare plan’s Part A and Part B. Most plans, fortunately, offer extra benefits which may include coverage for hearing aids, routine vision care, prescription drug coverage, fitness center membership, and even routine dental care.
Medicare Advantage Plans Typically Cost Less
When you sign up for a Medicare Advantage Cover, you still continue to pay the premium for Medicare Part B and may have to start paying for an additional premium. It is worth noting that it’s the insurance companies that determine how much you will pay a premium for the Medicare Advantage Plan. As a result, the amount you will be required to pay as a premium for a Medicare Advantage Plan varies from plan to plan. Some covers may have a premium that’s as low as 0 USD.
There is also a possibility that cost-sharing under your Medicare Advantage plan might be less. For instance, if you visit your primary care physician and have a Medicare Advantage Plan, you might have to pay a $10 copayment. However, if you visit your doctor using the Original Medicare cover, there is a chance you will have to work with a coinsurance of 20 percent, which could end up being more than 10 dollars.
Another good thing about Medicare Advantage plans is that they tend to limit the amount of money you spend out-of-pocket. Once you’ve spent the maximum amount, you pay nothing more for the medical services your plan covers for the rest of the year. This is unlike the Original Medicare cover, which doesn’t provide an out-of-pocket maximum spending cap. With the original cover, your potential expenses could be limitless.
In most cases, Medicare Advantage plans are less expensive than similar Original Medicare covers while at the same time they offer more. To enjoy all of the benefits a Medicare Advantage plan has to offer with Original Medicare, you will have to sign up for a Medicare Supplement Plan and a stand-alone prescription drug plan (Medicare Part D).
Learn more about and compare Medicare Supplement plans on Health.com’s review of the best Medicare Supplement companies
Medicare Advantage Plans Manage Care Amongst Your Primary Health Care Providers.
Plans under Medicare Advantage are, in essence, managed care and work with networks of different health care solutions providers in contract with Medicare. A good example is HMO or Health Maintenance Organization Medicare Advantage plans. These plans require that you choose a Primary Care Physician to help you coordinate your care.
Plans, including prescription drug coverage, could also include medication therapy management. This sort of care coordination improves convenience and can prove to be a valuable support to your health.
Medicare Advantage plans serve as a reliable ‘one-stop’ center for all prescription drug and health coverage needs.
Most Advantage plans combine Part D prescription drug and medical coverage. They also work on coordinating the delivery of different added benefits like hearing, vision, and dental care. You might prefer the convenience of working hand in hand with a one plan administrator.
Medicare Advantage Plans Cons
Medicare Advantage plans can, in some instances, limit your options when it comes to health care providers.
With the federally-administered Medicare Program, you generally can visit any facility or doctor that accepts Medicare covers and receives Medicare benefits for the services covered. However, it is worth noting that Medicare Advantage plans are a bit more restrictive when it comes to providers and provider networks. If you opt to see a physician that is outside the network, your Medicare plan might not cover your costs, or the costs might not apply to your out-of-pocket max.
The coverage for some procedures and services by your Medicare Advantage plan may require your doctor’s plan authorizations and referrals.
Medicare Advantage tries to prevent the overuse or misuse of health care using several options. This sometimes includes a prior authorization for home health care, hospital stays, certain complicated procedures, and the use of specific medical equipment. Medicare Advantage plans also tend to require that you get your primary care physician’s referral to see a different specialist before they can pay them for their services.
Medicare Advantage Plans cater to specific healthcare service areas.
Most Advantage plans have a regional rather than a national network of participating providers. To enroll for the cover, you must be a resident in one of the Medicare Advantage service areas for at least six months. If you spent your time between two different homes in two different areas, meeting this requirement could prove difficult.
When it comes to Medicare Advantage plans, the bottom line is that they may provide you with affordable coverage than you’d receive with other plans. The trade-off here is that you’d have to follow Medicare Advantages’ rules to receive payments for services covered.