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Medicare - Which Plan Should You Choose?

Posted by Mary O'Hara on Nov 16, 2017 11:00:00 AM

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Medicare open enrollment is happening right now, so it's time to enroll in a Medicare plan by going to the Medicare.gov website. Open enrollment closes on December 7, and new Medicare coverage begins on January 1, 2018. 

Understanding Your Medicare Options: Medicare Advantage 

The important thing to keep in mind is that Medicare Advantage covers all Medicare services, including hospital inpatient and outpatient care. Most plans cover prescription drugs as well. These plans may also include additional benefits, such as home-delivered meals, vision, hearing, dental, and wellness, that original Medicare does not.

Medicare Advantage goes by many different names - you may have heard it called Medicare Part C or MA plans ("MA" stands for Medicare Advantage).

Millions are Signing Up! 

Medicare currently has 44 million beneficiaries (about 15% of the current United States population). That number is expected to grow to 79 million (nearly double the current number) by 2030, according to a recent AARP report

So, how does Medicare Advantage work?  Medicare Advantage combines hospital costs and doctor and outpatient care all in one plan. It can also include a Part D for presciption drug coverage.

The original Medicare plan includes Medicare Part A (inpatient hospital stays, skilled nursing facility care, and hospice care) and Medicare Part B (outpatient care, doctors' services, and preventive services). Medicare supplemental insurance is only possible with a regular Medicare plan, not with Medicare Advantage plans. 

The original Medicare plan (Parts A and B) is a fee-for-service plan administered directly through the federal government. That's why you might have heard regular Medicare called "single payer" since you pay your deductible and coinsurance to just one other party. 

Medicare Advantage Could Mean Lower Copays, Greater Choice, and More Covered Services 

Medicare Advantage plans are sold by private insurance companies that are dedicated to providing quality Medicare services at competitive rates. Most Medicare Advantage plans are HMO (health maintenance organization) or PPO (preferred provider organization). 

For extra cost savings, you might want to explore a third kind of Medicare Advantage plan: private fee-for-service Medicare Advantage plans. Lower deductibles and an affordable fixed co-pay are common benefits to signing up for a Medicare Advantage plan.

Aside from potentially lower deductibles and co-pays, you might also benefit from lower out-of-pocket maximums with a Medicare Advantage plan, which means that your plan could cover 100% of your medical expenses once that yearly maximum is met. 

Medicare Advantage Prescription Drug plan is another option to explore if you take prescription medications and are concerned with affordability or a gap in coverage. 

With some Medicare Advantage plans you choose a primary care doctor. In others, you can go to any Medicare-eligible provider that accepts the plan's terms and payment rates. 

To find which plan works best for you, visit the  Medicare plan finder tool on Medicare.gov or you can also call 1-800-MEDICARE. Have the information on your Medicare card ready. 

Medicare Advantage Must Cover Medicare Services 

The great thing about Medicare Advantage plans is that they must cover all of the essential services that your original Medicare (Parts A and B) cover. This means that the following should be covered by Medicare Advantage: hospital inpatient, hospital outpatient, managed care, skilled nursing facility, home health, physician, and specialist (with referral). 

Many people like the added benefits that a Medicare Advantage plan offers. One benefit that is gaining popularity is a home-delivered meal benefit after a hospital stay. These meals can help your recovery, since preparing meals may be difficult after a hospitalization.

If you're looking to have all of your essential Medicare services covered, gain even more services that Medicare might not cover, and go through a private PPO for your Medicare needs, then you might want to check out a Medicare Advantage plan. Nearly ten million Americans have already done so.

Remember, open enrollment ends December 7!

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Topics: Medicare, Healthcare Research, Senior Health Plans, Senior Nutrition

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