Medicare Advantage plans are becoming increasingly popular among seniors who want to save money on their healthcare costs. However, choosing the right plan can be tricky.
There are several different types of Medicare Advantage plans available, each with its own benefits and drawbacks. In this article, we’ll discuss the pros and cons of these plans, so you can choose the best option for you.
What is a Medicare Advantage Plan?
A Medicare Advantage plan provides supplemental coverage in addition to your Original Medicare Part A & B insurance. MA plans offer additional services such as prescription drug coverage, vision care, dental care, hearing aids, long-term nursing home care, and more. They also provide extra help paying out-of-pocket medical expenses like deductibles and copays.
The main difference between traditional Medicare and an MA plan is that instead of receiving all of your health care through Original Medicare, you receive it from both Original Medicare and your private insurer under one contract called a “Medigap policy.” The Medigap policy pays most or all of your premiums while Original Medicare covers any remaining cost. You may have other options besides an MA plan if you don’t qualify for Extra Help. For example, some people prefer not to pay monthly premiums at all by using a Health Savings Account. Others might find a Preferred Provider Organization plan works better than an HMO because they get access to doctors outside their network.
The biggest advantage of having an MA plan over Original Medicare alone is that you will likely see lower overall costs. This is due to two reasons: First, since you no longer need to purchase separate policies, you won’t incur higher premium payments. Second, many insurers include discounts when offering their products to those enrolled in certain government programs, including Medicare Advantage. These discounts reduce your total bill even further.
However, there are downsides to enrolling in an MA plan. One major drawback is that you must use only approved providers within your network. If you go to a doctor outside of your network, you could face high co-pays and/or deductible charges. Another downside is that you lose the ability to shop around for cheaper prices. Since you already have a primary physician, you aren’t able to compare rates across multiple networks. Finally, you cannot switch back and forth between Original Medicare and an MA plan without losing your current enrollment period.
Types of Plans Available
In order to make sure you select the right type of plan for your needs, here are three basic categories of Medicare Advantage plans:
HMOs – An HMO offers a limited choice of physicians and hospitals. It typically has fewer provider contracts compared to PPOs, which means patients often have to travel farther distances to reach specialists. Some HMOs require members to visit specific clinics first before seeing a specialist. Other HMOs allow members to seek treatment anywhere but charge them higher fees for doing so.
PPOs – A PPO allows members to pick where they would like to go for treatment. Members usually do not have to wait for appointments; however, they may still have to pay higher fees for traveling to distant locations. Many PPOs cover prescriptions, though others limit what drugs they cover.
EPPs – An EPP provides more flexibility than either an HMO or PPO. Patients can generally see whichever medical professionals they wish as long as they stay within the boundaries set out by the insurance company. There are also no restrictions regarding how far away a patient should live to receive services.
What Makes Each Type Better Than Others?
Each type of plan comes with certain advantages over another. For example, some people prefer having access to a wider range of health care providers while other individuals enjoy being able to get prescription coverage. Here are some key differences between various MA plans:
HMO vs. PPO
An HMO will likely offer less comprehensive coverage than a PPO. This is because most HMOs restrict the number of doctors and facilities covered under their policies. They tend to focus on keeping costs down rather than providing quality service. On the flip side, many PPOs provide better coverage than HMOs. These companies strive to keep premiums low by offering extensive benefits packages. But since they rely heavily on referrals from participating doctors, they sometimes end up paying too much for treatments.
PPO vs. EPP
A PPO gives members greater freedom in terms of where they can go for treatment. Because there aren’t any limits placed on where they can go, members can easily find a doctor near home. The downside to this approach is that they must pay higher copays when seeking treatment outside of their network. If they opt for an EPP instead, they won’t face such high charges. Instead, they’ll only have to pay extra for travel expenses.
MA Plans vs. Traditional Insurance Policies
Some people believe that traditional insurance policies are superior to MA plans. After all, they argue, traditional policies allow patients to visit any provider without worrying about the cost. And unlike MA plans, they say, traditional policies typically include dental and vision coverage.
However, MA plans often come with lower monthly premiums than traditional policies. Plus, they usually cover more services than traditional policies do. That means that even though you may have to pay out-of-pocket for some things like prescriptions, you still receive full reimbursement for medical procedures.
In addition, MA plans also give you flexibility regarding how long you stay enrolled. With traditional policies, once you stop working, you lose your coverage completely. By contrast, MA plans let you continue receiving benefits as long as you remain eligible.
How to Know What is Right for my Needs?
Before deciding whether or not to sign up for an MA plan, consider your personal situation. Are you healthy enough to handle the rigors of visiting numerous doctors every year? Do you feel comfortable making decisions about your own healthcare? Is distance important to you? How much does your budget permit? Will you be moving soon? All of these factors play into determining which kind of plan is ideal for you.
If you answered “yes” to all of these questions, then it might be worth considering signing up for one of the above options. Otherwise, if any of the answers were negative, you probably shouldn’t bother looking at MA plans. You don’t necessarily need to stick with Original Medicare forever. As mentioned earlier, switching from Original Medicare to an MA plan isn’t easy. So if you decide to leave Original Medicare behind, make sure you know exactly why you made that decision.
If you’re looking for health insurance plans, you’ve come to the right place. We can help you choose the plan that best fits your needs. Call us today at Healthbridge Insurance Solutions and talk to one of our expert advisors!