What level of coverage for medical expenses will be right for you? Will you need Medicare basic and nothing else? Or will you need some additional coverage through Medicare Advantage plans? These are the questions that those eligible for these healthcare coverage plans should be asking. Medicare Advantage Plans for 2018 offer some great coverage options for those who can use them.
Now picking out the right plan for yourself can be tricky. You have to know what you actually need out of a coverage plan. That involves looking closely at your current medical expenses as well as those you might experience. Keep in mind that just because you haven’t had to pay a certain medical expense, that doesn’t mean that you won’t in the near future. It’s always a good idea to get a bit of extra coverage with your insurance plan, if you can afford it.
And Medicare Advantage plans can come with a lot of extra insurance. When compared to original Medicare plans, they are more robust. That also means they will cost more, in most cases, but you can still find some good deals on them. You can compare the rates between the insurance companies selling these plans. That’s going to take some work and effort from you, but it can be worth your while. You can save considerably on these high-coverage Advantage plans by shopping around for the best rates.
Even though the insurance companies selling these plans get to set their own prices, they don’t actually have any say over the coverage on the plans. Medicare sets up the coverage for itself, and the insurance companies selling the plans have to stick to what Medicare has established. They can change the rates all they want, but they cannot lay a finger on the coverage for Medicare Advantage Plans for 2018.
Where they can differ is in the networks they offer and the availability of coverage. For example, if you buy a plan from one provider and they have a small network, there may be no healthcare facilities near them that will actually be eligible for the plan you have signed up for. You could go to one of those hospitals and receive medical care and never be covered for anything, even though you have a robust coverage plan.
That’s basically how networks operate. The HMO network will only cover you if you go to a healthcare facility that is on the network of the company you bought the plan from. A PPO network gives you coverage everywhere, but only partial coverage at healthcare facilities that are not part of your insurance company’s network.
Accessibility of Medicare advantage plans can be through any private approved insurance company, the costs and benefits may differ in every plan, and also not all plans are available in all locations. There are many factors to take into consideration when you are comparing Medicare advantage plan some of which are;
- most Medicare advantage plans can have a monthly premium of $0, but keep in mind that you will still need to keep paying the Medicare part B premium, along with other co-payments, deductibles or/and co-insurance that are required by your plan.
- What are you previous coverage or out-of pocket limit? Unlike original Medicare (part A and B), Medicare advantage (part C) has specific yearly spending limit; which means once you attain this limit then Medicare advantage covers 100% of medical costs for the remaining part of the year.
- Is additional benefits part of your new plan? Benefits like routine vision and dental checks, hearing or health wellness programs, you need to know these when trying or comparing plans.
- You also need to find out, does the plan include prescription drug coverage, and are your current medications among the plan’s formulary or the list of covered drugs? What also is the co-payment or co-insurance for such drugs that you take (also have in mind that the plan’s formulary tend to change, although you will be notified if such change by your Medicare plan administrator if necessary).
- Will this plan have a network provider? If it has, then are your current doctors or health provider among the network? Also know that the provider network is subject to change too and will be notified if necessary.
- Is the plan star rating a quality score? Star ratings are ways to gauge a Medicare advantage plan’s performance or care. Each plan is usually given a rating of either 1-5 stars or 5 stars being the highest rating and represents a good and quality score. Medicare is responsible for evaluation of plan’s star ratings and they tend to change on a yearly basis.
Medicare advantage Plans in 2018 Vs Original Medicare
When you are enrolled in a Medicare advantage plan, you actually leave original Medicare (part A and part B. Services covered by Medicare are covered through the plan and not catered for under original Medicare. Medicare pays the insurance company when you enroll, and then the insurance company will in return pay for your Medicare approved health care costs, according to the benefits you opted for in your plan, so you will still have to pay some deductibles, co-pays and co-insurance. Your out-of-pocket cost will be lesser in some plans when compared with Medicare part A and part B alone, and most plans actually offer a maximum out-of-pocket dollar amount, thereafter, the insurance company would pay any other additional expenses occurred. Some of the Medicare advantage plan like prescription drug coverage (Medicare part D) at no extra cost, and still offer extra coverage such as vision, hearing, dental and/or health and wellness programs not generally covered by Medicare.
Medicare Advantage HMO vs. PPO
While you are comparing Medicare advantage plans in 2018 you see that most plans actually use either HMO or the PPO plan’s model. There are actually other types of plans available and they are available in the same location, so it is actually a good idea you had knowledge about them and how they differ:
(a) HMO (health maintenance organization plan):
Allows you to see doctors and other health professionals that are not active in that network, then the plan may not pay those health care costs except, for emergencies, out-of-area dialysis or out-of-area urgent care.
(b) PPO (also called preferred provider organization plan):
unlike HMO; PPO covers both in and out-of-area providers, giving you the freedom of choice of your own doctor, generally, higher co-pays or co-insurance for out-of-network providers will be covered by you.
(c) PFFS (private fee-for-service plan):
This plan actually pays a specific amount for health care services, and the amount has to be accepted by the treating doctor-even if it is less than the usual charge he receives, when the doctor disagrees then Medicare will not cover services through that doctor.
(d) SNP (special needs plans):
these plans are designed for people who have ‘special needs’ that includes those residing in a nursing home, individuals who are eligible for Medicaid, and those with chronic diseases or disabling conditions, such as diabetes, end-stage-renal disease (ESRD) or even HIV/AIDS.
(e)MSA (medical savings account plan):
This includes a high deductible and a bank account to help you pay the deductible. The amount usually varies depending on the plan. The funds are tax-free as long as you use it on IRS-qualified medical expenses, which include the health plans deductible. The majority of the plans are either HMO or the PPO type. So, you decide the best plan for you, if it is in your area, then you must know the provider network in the plan for Which you are eligible as a first step in making the proper decision
Basically, if you want the most coverage you can get, you need to go to a healthcare facility (that’s hospitals, clinics and doctor’s offices) that is on your insurance company’s network. You should make finding out about the company’s network a priority when looking for Medicare Advantage Plans for 2018. Their network will really determine how available your coverage is and if it is worth your while to purchase a plan from that particular provider.