Medicare Advantage Coverage
Medicare Advantage Plans are an alternative to Medicare supplement plans (also known as Medigap), and are also known as Medicare Part C. It is required to enroll in Medicare Parts A and B (traditional Medicare) before enrolling in a Medicare Advantage Plan. These plans act more like a typical insurance plan.
Since these plans go through insurance companies, the company you choose may be a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization). This is an important component to keep in mind when choosing. With an HMO, you have to choose a primary physician within their network, and will require your doctor to provide a referral if you need specialist care. You will be allowed to use out-of-network facilities during an emergency but otherwise, all care must be done in-network. With a PPO, you will not need to designate a primary physician and therefore do not need a referral to see a specialist. You are also allowed to receive care from an out-of-network physician or facility but it will result in higher out-of-pocket expenses.
Advantage plans carry some additional benefits to Medicare Supplement Plans but also have some drawbacks. Our skilled agents at Roaring Fork Medicare Coverage in Basalt can help you find the best rates for Advantage Plans and can also walk you through how these plans differ from Medicare Supplement Plans.
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Medicare Advantage Plan Benefits
An initial advantage to these types of plans is that your premiums may be lower than purchasing a Medicare Supplement Plan through the Medicare system. In fact, many plans offer $0 premiums, deductibles, and doctor visits. Many plans provide additional benefits that are not covered under Medicare Supplement Plans. However it is important to make sure these programs are available in your area.
Since there is less underwriting required for Medicare Advantage Plans, it is easier to obtain coverage when a health issue has prevented you from enrolling in a Medicare Supplement Plan. Your ability to enroll in an Advantage Plan begins a few months before you turn 65, and ends a few months later. After that, you may make changes, add, or drop your Advantage coverage during the open enrollment period.
Potential Downsides of Medicare Advantage Plans
You may be thinking that $0 premiums and expanded coverage sound like too good of an opportunity to pass up. While it is great to have that extra coverage at no additional costs, there are some caveats of which you should be aware.
Most Medicare Advantage Plans come with prescription coverage but it should be noted that you cannot be enrolled in Medicare Part D at the same time. Make sure the plan you are looking at covers your prescription needs.
Since these plans are provided by insurance companies instead of through the Medicare system, your current provider or hospital may not be in-network with the company you choose. You will also need to be aware that your benefits and in-network providers may change from year to year so a careful review of your policy and benefits on an annual basis will be important.
Our local agents are committed to finding the best plan for your needs and will help you review your plan and benefits each year to make sure it is still meeting your needs. Since we are an insurance brokerage, we can compare rates among the various companies and plans to find the best fit for you at the best rate. Since coverage changes from state to state and even county to county, let us do the legwork to find you your best options here in Basalt, Colorado.
As an additional benefit to you, we also offer Medicare prescription drug plans to help with any gaps in coverage provided by Medicare advantage.