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As Medicare premiums rise, a Medicare Advantage plan can seem like an attractive option. But if you are considering a switch from Original Medicare to a Medicare Advantage plan, you need to do a comparison of the two policies.
Medicare Advantage plans are run by private insurers, unlike Original Medicare. The federal government operates the Medicare Advantage plans, although the medical providers are private. The government pays a fixed monthly fee for Medicare Advantage plans to provide services to each Medicare beneficiary under their care. The plans often look attractive because they provide the same basic coverage as original Medicare as well as additional benefits and services that Original Medicare does not offer.
To compare Advantage plans, go to the Medicare Plan Finder at Medicare.gov. When deciding if a Medicare Advantage plan is right for you, consider the following factors:
Since Medicare Advantage plans are offered by private insurers, the cost of the plan differs depending on where you live. While Medicare Advantage plans usually have lower premiums than paying for Original Medicare plus a Medigap plan, they can have higher deductibles and co-pays in certain circumstances. Therefore, you need to take that into account when calculating the cost of each plan. Medicare Advantage plans do have a cap on out-of-pocket costs, while Original Medicare does not. Make sure to check the annual maximum out-of-pocket costs for the plan. If you have a high level of health costs, a low out-of-pocket maximum may be the best option.
What coverage does the plan offer? Medicare Advantage plans must cover everything that Original Medicare covers, but some plans offer additional benefits such as dental, hearing and vision. Although, plans may require your doctor to get approval for certain procedures. If plan administrators disagree with your physician in a procedure being medically necessary, the plan may refuse to pay for it. You will need to find out how the plan decides on treatment approvals, referring patients to specialists or allowing patients to remain in the hospital if they are not ready to leave. You may also want to check with your doctor to find out their experience with the plan and whether or not it frequently overrules the doctor.
Original Medicare does not have any restrictions on which doctor you use, but Medicare Advantage plans are HMOs and PPOs, which means that not every doctor accepts the insurance. With an HMO, if you visit a doctor outside of the network, you will likely have to pay out of pocket (except in an emergency). With a PPO, you can usually see any doctor you want, but you will pay less for an in-network doctor. You will want to check to see if your doctor and hospital are part of the plan’s network. The best way to do this is to call your doctor’s office to confirm.
Most Medicare Advantage plans include prescription drug coverage, so you should check to make sure the plan covers all of the medications you take. You should also check to see if any special authorizations are needed for any of your medications, or if there any limits on the amount you can get. Other questions include whether or not your pharmacy is a preferred provider, as well as whether or not you can get prescriptions by mail.
Quality of Care
The Medicare Plan Finder includes a rating system that measures how well it manages health screenings and chronic conditions. It also tallies how many customer complaints it receives, among other things. The ratings mat not be perfect, but they can give you an idea of the plan’s quality.
- Read additional information about Medicare Advantage.