Should I switch to a Medicare Advantage plan?

October 21, 2017

Retirement Living Staff

Medicare Open Enrollment season has returned for 2017, and runs from October 15 – December 7. Many seniors are wondering if they should enroll in a Medicare Advantage Plan. If you haven’t heard of Medicare Advantage, maybe you should be considering it too. But how much do you really know about it, and does it make sense for you? If you are currently enrolled in Medicare Parts A & B, you are probably eligible to enroll in Medicare Advantage. Before you make a switch, consider the facts.

medicare discussion

Doctor-patient discussion. Source: Getty

Medicare Advantage coverage

Medicare Advantage plans generally offer the same benefits as Original Medicare, as well as some additional benefits. That means Hospital Insurance (Medicare Part A) and Medical Insurance (Medicare Part B) are both covered under Medicare Advantage. Many Advantage plans will also cover additional benefits, like prescription coverage, dental, vision, and wellness programs, which is why some seniors prefer the Advantage plans.

Medicare vs. Medicare Advantage

Although all Medicare Advantage plans cover Part A and Part B components, not all Medicare Advantage plans are the same. You’ll probably recognize the Medicare Advantage plan types, which include HMO and PPO. The reason these plans resemble traditional employer plans is that Medicare Advantage plans are actually offered by private companies that are approved by Medicare and paid for (in part) by your Medicare benefits. The extra benefits that come with most Advantage plans aren’t free, as beneficiaries usually pay a monthly premium on top of their Part B premium. You’ll want to make sure you fully understand the benefits and premiums you’re committing to before making a change.

Financial benefits of Medicare Advantage

Medicare Parts A and B will not cover all your medical expenses. If you are on a fixed income, unexpected medical expenses and prescriptions can quickly eat away at your savings. Many seniors prefer these Medicare Advantage plans to Original Medicare because they limit their out of pocket expenses from copays, deductibles, and prescriptions. Of course, there is no free lunch, so you’ll probably end up paying for these things in one form or another, whether it’s in the form of co-pays or monthly premiums.

Limitations of Medicare Advantage coverage

There are some issues with Medicare Advantage plans that you should consider, because your care will be managed differently. For instance, with HMO Medicare Advantage plans your costs may be higher for out of network providers, and your current doctor or providers may not be in-network. Moreover, the timing and accessibility of treatment options may be limited. Check to find out if the plan you select requires pre-authorization for procedures. You may even be subject to spending limits for catastrophic illness treatments. You’ll want to do your research about the limits of coverage before you pick a plan.

Medicare supplement

If you are 65 or older and enrolled in Medicare Part B, you have a six-month open enrollment window for Medicare supplement insurance. These supplement plans may work as an alternative to Medicare Advantage if you’re eligible. Find out how to buy Medicare supplement insurance.

If I switch to Medicare Advantage, can I switch back?

Yes, during the next Medicare Open enrollment period you can switch back to Original Medicare. During Open Enrollment, you can also switch from one Medicare Advantage plan to another should your needs change.

Conclusion on Medicare Advantage

Medicare Advantage plans are a good option to offer additional coverage over Medicare Parts A and B, and they allow you to limit your out-of pocket expenses for services not covered under Original Medicare.



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