Medicare Advantage Plans: Make an Informed Decision

People who qualify for Medicare Advantage Plans are making use of the opportunity to get their Medicare Part A and B medical benefits from private insurance companies. These companies are approved by Medicare to ensure that members receive their benefits. 

Many people make use of Medicare but, upon doing so, find that there are a lot of additional expenses for which they remain responsible. By using a Medicare Advantage Plan, you will access reduced out-of-pocket expenses than you would on Original Medicare.

Here’s what you need to know about qualifying for a Medicare Advantage Plan.

Plans operate within service areas

A service area is a designated region in which a Medicare Advantage Plan is licensed to offer coverage. The state is responsible for the licensing, and it is subject to Medicare approval. Within this service area, there are networks of healthcare facilities and practitioners responsible for delivering the covered services. 

You need to apply for a Medicare Advantage Plan that operates in the area in which you live. It is also vital that you have a list of the approved facilities and professionals you are authorized to use.

Qualification for Part A and Part B Medicare coverage

An important eligibility factor when it comes to the Medicare Advantage Plan is that you have to qualify for Medicare Part A and B. People over the age of 65 automatically qualify, as do some people who receive certain disability benefits. This rule continues to apply for the Medicare Advantage Plans 2021 will have available.

Part A of Medicare relates to hospitalization, while Part B is medical insurance for non-hospital treatments. Your Medicare Advantage Plan does not replace the coverage Medicare offers. All it does is provide you with an alternative way to access these benefits via a private insurance company that Medicare has approved.

Not only do you need to qualify for Medicare Part A and B coverage, but you also need to remain enrolled for them. If you try to disenroll yourself from Part B, your Medicare Advantage Plan will kick out any claims you make.

The dreaded Part B payment

Even with a Medicare Advantage Plan, you remain responsible for paying the difference between Medicare covers and what the healthcare professional charges. 

This is 20% of the total, and there is no cap on the maximum amount you will need to pay on Original Medicare. Your Medicare Advantage Plan might offer capped out-of-pocket maximums. This can be advantageous in the event of prolonged treatment for a chronic condition.

You are also liable for the monthly Part B premium, regardless of which Medicare Advantage Plan you choose. Find out if you qualify for a Part B premium subsidy from the government. Eligibility is based on your income. 

There are added benefits

Utilizing a Medicare Advantage Plan provides you with some additional services you would otherwise not have access to. These include routine dental and vision costs, wellness programs, and prescription drug costs. You should also find out about other benefits, such as gym memberships.

The price of a Medicare Advantage Plan might pleasantly surprise you. Some companies offer them at a zero premium. Others are competitively priced, with premiums payable monthly. 

Save the date

The Open Enrollment Period (OEP) is an important date for Medicare Advantage Plan users to keep in mind. During this time, you can switch service providers or drop your plan and revert to Original Medicare. 

Outside this window of time, you may not make any alterations to your Medicare Advantage Plan. The exception applies to those who might lose their coverage after moving out of the service area. It is called a Special Enrollment Period.