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Medicare is a federally administered health insurance program that is primarily for people 65 or older, as well as those below that age threshold that have disabilities, and those with end-stage renal disease. It can be difficult to understand and unravel the complexities of Medicare coverage, but finding the right Medicare coverage can be very important to ensure you are maximizing this resource. Here, we will discuss one aspect of Medicare and that is Medicare Advantage.

What Is Medicare Advantage?

Medicare Advantage is a rather unique Medicare plan as it is a type of Medicare health insurance that is offered by private companies, as opposed to the federal government, that have been approved by Medicare. Also referred to as Medicare Part C plans, it is offered as an alternative to Original Medicare. Medicare pays the premiums for Medicare Advantage plan participants. Medicare Advantage plans include the coverage provided by Medicare Part A and Part B. Additionally, the majority of Medicare Advantage plans include Part D prescription drug coverage.

So, should you choose a Medicare Advantage plan? There is no easy answer to this question. It will require a detailed analysis of your preferences and lifestyle as well as your health insurance coverage needs. There are, however, a few reasons why some tend to prefer Medicare Advantage coverage. For instance, Medicare Advantage plans often offer more insurance benefits than those under Original Medicare. While Medicare Advantage plans are required to offer the same coverage level as Medicare Part A and Part B, there are many Medicare Advantage plans that offer additional benefits such as routine vision care and dental care, as well as hearing aids and prescription drug coverage.

There are also several ways that Medicare Advantage may end costing you less than Original Medicare. The Medicare Advantage insurer you select will set the plan’s premium and, therefore, premiums can differ from one plan to the next. Some Medicare Advantage plans even have premiums set at no cost. Cost-sharing may also be lower and a Medicare Advantage plan places a limit on your maximum out-of-pocket expenses. As soon as you have reached the limit on your out-of-pocket expenses, you will not have to pay for anything for covered medical services for the rest of the year. Original Medicare does not have a cap on out-of-pocket expenses and so there is no limit to your potential out-of-pocket expenses.

There are, however, some potential downsides to Medicare Advantage. For instance, it may seriously restrict your ability to choose your health care providers. Under Original Medicare, you are usually able to have covered visits at any doctor or healthcare facility that accepts Medicare. Medicare Advantage plans, however, can be much more restrictive in regard to their provider networks. Should you go out of network, your Medicare Advantage plan is likely not to cover the cost of your visit.

Furthermore, many Medicare Advantage plans require you to jump through additional hoops for certain treatment needs. For some services and procedures to be covered, you will need a doctor’s referral and plan authorization. You may need this before you see a specialist that will be covered under your plan. You may also need this authorization prior to things such as hospital stays, getting covered medical equipment, and having access to covered home health care, among other things.

Elder Law Attorneys

Do you have questions about Medicare coverage? You are not alone. Talk to the knowledgeable elder law attorneys at Merlino & Gonzalez. We have answers for you. Contact us today.