Medicare Advantage- The Real Pro’s and Con’s
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Medicare Advantage: The Real Pro’s and Con’s: If you have watched any television recently, you will more than likely have seen an ad for a Medicare Advantage program. You will have likely have seen some of these Medicare Advantage programs have a zero premium or in other words ” Your Medicare Advantage Program is free”. These types of programs are very appealing to some people, but you have to make sure you clearly understand what a Medicare Advantage program will and will not do for you. Additionally, there are two types of Medicare Advantage programs so here we are going to peel off the cover of these programs and help you understand how these this type of Medicare Advantage program may or may not help you.
First, if you are soon to turn age 65 you are likely getting bombarded with solicitations on both the Medicare Advantage and Medicare Supplement programs. Your initial eligibility to enroll in these types of programs is generally 3 months before your birth month, the month of your birth day and three months following your birth month. Also, please note, any Medicare Advantage or Medicare Supplement will be effective on the first day of the month.
So what is a Medicare Advantage program and how does it really work?
Assuming you have a general understanding of the Four Parts of Medicare and if not here is a link to Medicare Part A, B, C and D. I also assume you have Medicare Parts A and B already in place, understood or have applied for Medicare Part A and B.
Well, a Medicare Advantage replaces traditional Medicare or Medicare Parts A and B. If you do not select a Medicare Advantage and just go with Medicare, than your claims are handled by Medicare. If you have a Medicare Advantage plan than you are working with a traditional Medicare Insurance carrier such as AETNA, Medical Mutual or Blue Cross Blue Shield or one of the many other carriers involved in the Medicare Advantage.
What is a “regular” or “traditional” Medicare Advantage?
Well this is where the “free or zero premium” Medicare differs greatly. The Medicare Advantage program that is advertised as “free” or zero premium, generally involves a VERY NARROW network of doctors and hospitals. I want to stress the word very narrow networks. The networks is something you really have to do your homework on because you may be in for a very big surprise. For example, many larger cites and even some rural facilitities have more than one hospital. It is not unusual for these Advantage networks to include one facility and not the other one. Further if you travel outside that network, let’s say you go on vacation, and need some healthcare, if you are outside your Advantage network you may ( and probably will NOT ) have access to a in network doctor or hospital. Of course if you are having a life threatening illness like a heart attack or become unconsciousness, you would be more than likely have coverage for that particular injury or illness. But, if you are in need to see a doctor and your illness or sickness is not considered life threatening, you probably do not have any coverage and will have to pay the entire claim.
What is a Medicare Advantage ” select” plan?
This plan works similar to the traditional Medicare Advantage plan mentioned above with one basic exception, the network is a bit larger than the traditional network mentioned above, however you still will not have nationwide access to hea;th are, doctors or hospitals. The select plan does have a premium associated with the plan. The chart below will illustrate some actual pricing samples, however your rate in your particular zip code or county will be unique to that area.
Not to be too confusing but just to be clear, some insurance carriers offer one or the other type of plan above while others will offer both a select and a traditional Medicare Advantage plan.
Two final issues to be sure you are aware of:
1.There has been much in the news about the longevity and sustainability of the Medicare Advantage programs going forward in the news today. You can just “Google” the subject.
- There has also been a two surprising lawsuits, brought about by the “Federal Government” against two of the top insurance Medicare Advantage carriers “over charging” the Federal Government. These lawsuits are very disturbing and concerning to those in the industry.
- You should check out the history and financial stability and ratings of these particular Medicare Advantage carriers.
- When considering your health care needs as you turn 65, you really should also investigate the Medicare Supplement programs as well. Many of the limitations mentioned above ad in particular with a Medicare Supplement will give you to IN NETWORK access to heathcare providers across the county. Basically, if you have a Medicare Supplement plan and the facility or hospital accepts Medicare ( which most do across the country ) you will have in network care for both life threatening care along with routine care.
Finally, as one last word about Medicare Advantage, some of the plans include additional benefits such as dental, vision or hearing. Some plans even include a Drug Card. Generally the dental, vision or hearing are many times simply a discount program. Check out your actual drug prescriptions with that particular drug card benefits. You should be able to find out your exact co-pays for those drugs. It may or may not be sufficient.
Some Medicare Supplement plans also offer discounts on dental, vision and hearing as well, but they do not provide drug benefits. Be sure to ask about the Silver Sneakers program that different carriers are offering. This is a free gym membership that all my clients love and in fact many tell me to be sure to place them with a carrier offering Silver Sneakers.
Believe me, I understand how confusing Medicare can be. It truly can be overwhelming.
My passion as a Medicare Expert is to help you navigate, educate, and understand and to you enroll in the best plan for you. I am NOT a call center and will likely answer your call when you call me directly at 877-549-1212. I set aside time every day to help you avoid choosing the wrong Medicare Plan. My consultation is completely free, for a limited time only. I invite you to contact me personally to discuss your situation, while I still have the time. I have 29 years of expertise in Medicare and I look forward to helping you with your insurance needs.
Call me today at 877-549-1212
