Defining what is a Medicare Advantage Plan, Key differences between types of Medicare, and signing up for Medicare.
1. What is Medicare Advantage Plan?
The Centers for Medicare and Medicaid Services (CMS) oversees Medicare. The CMS contracts with private companies that create Medicare Advantage plans that are offered to eligible seniors. A Medicare recipient can then enroll in regular Medicare or a Medicare Advantage plan. The Medicare Advantage plan aims to keep you healthy, provide quality care, and improve wellness. An original Medicare plan would be considered a Fee For Service plan.
2. What are some of the key differences in health benefits that are offered through Medicare Advantage plans?
Teeth, Eyes, and Ears! A Medicare Advantage plan can include additional benefits that regular Medicare does not provide. For example, many Medicare Advantage plans provide dental, vision, and hearing (audiology) benefits; otherwise, the senior beneficiary would have to pay out of pocket. Additionally, most Medicare Advantage plans offer drug coverage which can be very expensive if one pays out of pocket. Some additional benefits that some plans offer are over-the-counter benefits, meals, remote access, acupuncture, and transportation. Some of these benefits are also helpful to the home caregiver who is caregiving for a loved one. Each year the benefits change, for example, a couple of Medicare Advantage plans increased their levels of in-home support for 2023.
3. What are the costs of regular Medicare versus Medicare Advantage Plans?
Although costs vary, generally speaking, the premiums are lower or even $0 with the Medicare Advantage Plans. Copays can be lower as well. When looking at costs, it’s good to consider to include the savings from the additional benefits received from the Medicare Advantage Plans. Each firm can provide several different plans you can choose from which differ in cost. For example, UnitedHealthcare is one of the largest firms(companies) offering Medical Advantage plans, but within UnitedHealthcare, there are several plans to choose from. In 2023, there were a total of 9 firms offering a total of 43 plans.
4. What is the key difference between Medicare Advantage plans and traditional Medicare?
The most significant difference you’ll notice with the Medicare Advantage plan is the network of providers and doctors you can see. Each Medicare Advantage plan has a network of doctors and providers you can choose from, and the doctor or provider you currently see may not be a part of that network.
For example, you’ve been seeing Dr. Jackson for several years and continued seeing Dr. Jackson after you turned 65; now you’re 70 and enrolled in a Medicare Advantage. Dr. Jackson is not in the network of the Medicare Advantage plan, and you have other Dr.s and providers to choose from. The Medicare Advantage plans you choose will give you a list of all the providers you can choose from.
Note: Emergency visits and urgent care visits are typically covered nationwide.
5. Are the Medicare Advantage plans a new thing?
Medicare Advantage plans have been around for over fifteen years. Recently, its popularity has significantly grown due to the lower costs of premiums and the services it provides the Medicare Advantage plan members. Many Medicare Advantage plans include additional benefits that regular fee-for-service/traditional Medicare doesn’t offer. Medicare Advantage plans were created to drive innovation and plan design.
In Jan 2023, the number of individuals enrolled in Medicare Advantage plans surpassed 30 million people, and the number of traditional Medicare was just under 30 million people. Therefore, more individuals are enrolled in Medicare Advantage plans than the regular fee-for-service. Additionally, Medicare Advantage plans understand the importance of staying healthy at home, and offer a variety of services that traditional Medicare doesn’t provide, some plans, for example, provide Part B rebates, telemonitoring, transportation, and bathroom safety.
6. Does the traditional Medicare or Medicare Advantage plan leave you exposed to additional out-of-pocket expenditures?
Generally speaking, the Medicare Advantage program can offer not only more security but also minimize the additional out-of-pocket risk associated with care requirements that can be expensive. Please read all benefits carefully of the Medicare Advantage plans, but the goal of the Medicare Advantage plan is to put a cap on medical expenses. Medicare Advantage plans continue to adapt and evolve to meet our current population’s needs and care requirements. In a traditional Medicare Fee For Service model, you may be exposed to risk of for a lot of expenses you did not account for. Therefore, out of pocket expenditures are typically higher in traditional Medicare Programs.
7. I have specific needs or am a part of a particular population. Would a Medicare Advantage plan be right for me?
Medicare Advantage plans to continue evolving to meet specific populations’ needs, address particular diseases, and look at the population as a whole from a health equity standpoint. The nice thing about Medicare Advantage plans is you can choose which plan to enroll in. Various firms and companies have contracted with the CMS and developed Medicare Advantage plans, and one of them may be right for you or the person you care for. The CMS recognizes that Medicare Advantage plans are a critical par of advancing health equity.
8. What if I sign up for a Medicare Advantage plan and I don’t like it? Can I switch back to regular Medicare?
Yes. You can switch between Medicare Fee For Service and Medicare Advantage plan typically during the Medicare Annual Enrollment Period and the Medicare Special Enrollment Period. Therefore, your “risk” of trying out a Medicare Advantage plan is ultimately one year. There are some plans where you can switch plans more often, and please ask the author for further detail.
9. I am a home caregiver taking care of a loved one. What benefits can a Medicare Advantage plan offer me to help care for my loved one?
With the innovation and the plan design of many of these Medicare Advantage plans, I’d encourage you to do your research and find a plan that is designed not only for the person you’re caring for but also for you as a caregiver. Some Medicare Advantage plans realize how vital home caregiving is and how resource-depleting home caregiving can be. The goal of the Medicare Advantage plan is to keep the individual healthy, and often, helping with home caregiving does just that. Therefore, look at the benefits that some of the plans offer such as transportation, bathroom safety, over the counter help, remote access and meals.
10. I’m considering moving into an assisted living community. Is there a Medicare Advantage plan this is right for me?
Several senior living operators are realizing the importance of clinical outcomes and ensuring you live well and are healthy for a long time. Additionally, some senior living operators are partnering and collaborating with Medicare Advantage plans to keep the resident healthier for longer. When searching for a senior housing provider, ask what type of clinical outcomes they focus on, what providers and therapy they offer, and what clinical programs do they have in place to reduce the risk of complications or incidences that can be costly. Ultimately, staying healthy means providing upstream prevention programs to minimize into downstream complications.
Final Thought: Ultimately, the goal of a Medicare Advantage plan is to provide Great Access to Quality Care at an Affordable Cost.
