Especially as you age, your ability to maintain health and wellness largely depends on you holding comprehensive health-care coverage. Good insurance grants you affordable access to doctor’s visits, hospital stays, preventative tests such as ultrasounds, and virtually any other care you may need.
Thankfully, various programs can provide you with reliable coverage. Among these are Medicare Advantage plans, which may offer cost savings for care and other potential benefits. If you’re reviewing your coverage options, take a look at the fundamentals of these plans, when you can qualify, and how they may help you stay on top of your health-care needs.
Before diving into Advantage plans (also known as Part C), you should know some basic details about the Medicare insurance system. Medicare offers federally sponsored health coverage to Americans aged sixty-five or older and those with certain disabilities or conditions, such as end-stage renal disease or ALS. Some people may also qualify for Medicare early if they begin receiving social security benefits before they turn sixty-five. This system was founded to ensure aging individuals had access to comprehensive health care at affordable rates.
However, these rates may vary depending on your plan type. While Part A, which includes various hospital services, is available at no cost, Part B (physician and outpatient services) and Part D (medication coverage) generally require that you pay monthly premiums. Additionally, enrollees will be responsible for fees for certain health services, such as copays for doctor’s visits.
A health-care advantage
Medicare Advantage plans offer potentially cost-saving solutions to this system’s somewhat inflexible coverage options. Known as Part C, these government-approved policies replace Medicare with private insurance that supplies the same services but at a potentially lower cost. Here’s a breakdown of their chief benefits.
A broad range of services
These plans provide virtually all Part A and Part B services as well as, depending on the policy, Part D’s prescription coverage and other benefits Medicare may not offer, including vision and dental programs. Some Part C coverage even grants you gym memberships, transportation to doctor’s visits, and other appealing perks. Depending on the insurer, you may also receive Medicare Part D’s prescription coverage.
Many Part C plans have an annual maximum, or a limit to the amount you must pay out of pocket for health services per year. Once you reach this maximum, all subsequent covered services will be paid in full by your insurance; traditional Medicare doesn’t extend such a benefit.
If you’re seeking a plan with lower cost-sharing rates, including the deductible, coinsurance, and copays, a Part C plan may require these payments for fewer services. This could be a huge plus for those with chronic conditions or a need for frequent health-care visits.
Often more affordable than traditional commercial insurance, Medicare Advantage plans may simply require you to keep paying your Part B premiums, which all Medicare members must pay anyway, to receive coverage. This means that all you may need to do is opt in to start receiving free Part C benefits. However, other plans may have higher premiums in exchange for perks like low cost-sharing rates.
How to enroll in Part C
There are two main ways to obtain an Advantage plan. For one, within the first three months of enrolling in Medicare, you can choose to apply for Part C coverage; note that you must enroll in traditional Medicare during the open enrollment period, October 15–December 7, before you can select an Advantage plan.
The following year after enrolling in an Advantage plan, you can change to another policy or drop it entirely and return to original Medicare during Part C’s open-enrollment period (January 1–March 31). You may also be able to adjust your coverage outside the open enrollment dates if you experience a qualifying life event, including divorce, losing your job, or moving to a new home.
Your experience with Medicare Part C will vary depending on which insurer you select and the type of plan you enter, such as a PPO or HMO policy—these plan types affect your premiums, choice of health-care providers or facilities, and more. Also, it’s important to review the services that certain Advantage plans do not cover, including hospice services and clinical trials, to ensure your health needs are met.
Because your insurance can significantly impact your health-care access and costs, consider shopping with an insurance professional to better ensure you obtain suitable coverage at a rate that works for you. When you find an appropriate policy, whether or not that’s a Medicare Advantage plan, you can pursue necessary health care with greater confidence and peace of mind.