Is Medicare Advantage Right for You?
Should you enroll in a Part C or Medicare Advantage plan? During Open Enrollment, there will be a lot of ads about Medicare Advantage that may not even tell you that Medicare Advantage is a Part C Medicare plan. Part C is the part of Medicare that pays private insurance companies a fixed amount every month to take care of you.
These managed care plans wrap all the parts of Medicare into one package – your hospital care, physician services, prescription drugs, and the extra benefits like vision, dental, hearing aids, and gym memberships.
Why You Might Want a Medicare Advantage Plan
The pros of Medicare Advantage plans are the added benefits and the apparent cost savings. You may not even have a monthly premium at all, or a low one depending on where you live and the plan you choose. You will have a maximum limit on any out-of-pocket costs, something Original Medicare does not offer1.
For people who are relatively healthy in their mid-60s, Medicare Advantage plan premiums look attractive and the plan is simple without a lot of complicated claims and bills. At the same time, if you have multiple conditions and a lot of different doctors, the apparent cost savings and simplicity of plan design may also be attractive. In addition, if you are eligible for both Medicaid and Medicare or have a specific disease, you may qualify for a Special Needs Plan with almost no costs to you at all2.
Medicare Advantage plans are not without costs, however. While the monthly premiums may be low, there are charges for doctor visits, emergency room visits, lab tests, and specialists. There may be a charge for your hospital deductible and you will pay coinsurance for every day you spend in the hospital.
Because these plans are “managed,” their network of providers (doctors and hospitals) will be limited and may not include providers in other states if you travel. Most of the plans are HMOs (Health Maintenance Organizations), which means you must see a provider in their network in order to be covered.
The PPO models (Preferred Provider Organizations) will have more expensive monthly premiums but allow you to go to out-of-network providers for an added cost.
If you are satisfied with the providers in your area and your preferred hospital and doctors are included in the plan, a Medicare Advantage plan may be the right choice for you. However, since leaving a Medicare Advantage plan may mean higher costs and even rejection by other plans, you will want to stay with your plan permanently.
1In 2021, the out-of-pocket limit for Medicare Advantage plans may not exceed $7,550 for in-network services and $11,300 for in-network and out-of-network services combined.
OpenMedicare helps seniors navigate some of their most important decisions around health and wellness.