Medicare Advantage Plans To Explore

Medicare Advantage Plans To Explore

Healthcare for aging populations is a concern for many countries in the world. Yet, these demographics need the services more than younger people. Many are living with at least one chronic condition that needs proper care.

Accessing healthcare in the US can be a nightmare. Only those with insurance or cash have quick access to the relevant services. As a result, many people would rather postpone seeking treatment. Others who have no choice but to seek health care services will fall into serious medical debt.

As of 2020, over 31 million Americans did not have medical insurance. Approximately 18,314 Americans between the ages of 25 and 64 will die every year due to a lack of healthcare.

Programs like the Affordable Care Act make it possible for the uninsured to get medical care. The same applies to Medicare, which we will discuss in our article below.

Understanding Medicare Health Insurance Program

Medicare is a federal health insurance program. In the beginning, the cover was for individuals falling within the 65 years and above age bracket. Over the years, the coverage expanded to younger people living with disabilities.

The programs also extend to those with permanent kidney failure. Such patients may need transplant or dialysis. As of 2022, Medicare covers 18.5% of the population.

How to Apply For Medicare?

You can apply for Medicare three months before turning 65. You can also do so during your birthday month and the next three months. Visit the Medicare website because they have a lot of information relating to the Initial Enrollment Period.

It also outlines what you need to know. Those who receive Social Security, for instance, get automatic enrolment. If you don’t, you will need to enroll in the plan.

There are different coverage choices under Medicare:

  • Original Medicare covers part A or hospital insurance and B or medical insurance. Medicare will pay a part of the medical fee based on the pre-approved amount. You pay the other part using your deductibles or coinsurance.
  • Medicare Advantage or Plan C brings in the services of private insurance companies. We will explore this in more detail as we look at the medical plans to explore.

Medicare Advantage Plans

Medicare Advantage falls under private insurance companies. These companies get into a contract with Medicare or Medicaid services. Do note that you must have enrolled for Plan A and B to qualify. This means you get the benefits of the original Medicare and a few other extras. These include dental, visual services, and even fitness programs.

There are many Medicare options, depending on where you are. When looking for the best Medicare plans, look out for the following:

  • Zero or low monthly premium
  • A low limit on out-of -pocket expenditure. Part A and B do not put a cap on such expenditure the Medicare Advantage will. If you reach the maximum amount, the insurance will cover the extra cost.
  • Coverage scope for benefits that do not fall under original Medicare. These should include reduced cost-sharing, transportation, dental, and vision. Others are telemedicine, rewards, and incentive programs

Let’s explore the best Medicare advantage plans now.

1. HMO or Health Maintenance Organization Plans

HMO plans limit you to the plan’s network providers. But there are some instances when you may need to go out of the pre-set coverage area to get care. The exceptions fall under the Point of Service Option (POS). Such include out-of-area dialysis and out-of-area urgent care.

Ensure that the HMO plan you sign up for covers prescription drugs. You also can apply for Plan D or Medicare drug coverage. The plan also requires you to decide on your preferred primary care doctor.

Accessing health care services outside of the HMO network may make you liable for the total cost. Avoid this by ensuring you get prior approval before seeking such services.

2. Medicare Advantage PPO or Preferred Provider Organizations (PPO)

Like in the case of the HMO, PPO also has a network of professionals. In addition, you also have leeway with seeing doctors outside of the network. The downside is that monthly premiums will be higher than what you pay for HMO. The same applies to co-payments or insurance for such care.

Ensure you keep good records. You may need to share information on out-of-network prescriptions and medical care.

3. PFFS or Private Fee for Service

PFFS plans fall under private insurance companies. The plan takes care of part of the cost while you are liable for the other. It will decide how much you will pay. It has a network of healthcare providers. Non-urgent care from other providers makes you liable for the cost. Some plans will cover prescription drugs. If not, then you can apply for Plan D.

4. SNP or Special Needs Plans

SNP plans are only available to individuals with specific characteristics or diseases. Such include:

  • Individuals living in institutions or communities give nursing care
  • People who qualify for Medicaid and Medicare
  • Those with disabling or chronic conditions. These include diabetes, HIV/AIDS, dementia, or chronic heart failure. Some SNPs will limit membership to one chronic disease. Others will take on a group of related chronic illnesses.

There is a network of healthcare providers who specialize in those specific conditions. You will also need to choose the primary care doctor or coordinator under the plan.

You can also seek out-of-network services. but do seek approval first from the SNP provider. Moreover, you may also want to see how much you will need to pay out-of-pocket. SNP covers Part D, which is prescription drugs.

If you need to see a specialist, you will need a referral from the SNP. But this does not apply to situations like annual mammogram screening. Others are pelvic exams, or pap smear tests in-network.

Final Thoughts

Take the time to read more on the different Medicare advantage plans. What we have provided is an overview of important information.

As we said, the coverage plans and scope may vary depending on where you are. Texas Medicare Advantage plans could be different from those available in other states. This is because the services are available through private insurance companies.

However, the same does not apply to Medicare Part A and B, which are federal programs. That means the coverage is the same no matter what part of the country you are in.



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