Medicare Advantage Plans Part 2
By Gary Phillips
How Much Does a Medicare Advantage Plan Cost?
Typically you pay monthly premiums in addition to your Part B premium. Each MA Plan can charge different out of-pocket costs for various services, so it’s wise to carefully compare apples to apples.
Out-of-pocket costs depend on:
- Whether the plan charges a monthly premium and how much.
- Whether the plan pays any of your monthly Part B premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayments or coinsurance).
- The type of health care services you need and how often you get them.
- Whether you follow the plan’s rules, like using network providers.
- Whether you need extra benefits and if the plan charges for them.
- The plan’s yearly limit on your out-of-pocket costs for all medical services.
How to Join a MA Plan
Since MA Plans can vary widely, it’s a good idea to take the time necessary to compare plans in your area. You may be able to join by completing a paper application, calling the plan, or enrolling on the plan’s Web site. Medicare also has information to help you compare plans.
A Few More Items to Consider
- You can only join (or leave) a plan during certain times of the year.
- You still have all of Medicare’s protections and rights.
- Become familiar with the plan rules, like getting a referral to see a specialist, prior approval for certain procedures, going to certain facilities, etc. Breaking the rules can lead to higher costs and penalties, depending on the type of plan you choose.
- You can join a MA Plan even if with a pre existing condition, except for ESRD.
- If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.
Things to Remember
Companies can end their annual contract with Medicare and pull out. For example, if claims become too high or payments from Medicare too low for a particular region, they have a business decision to make. They are required to give their policy-holders ample notice, but it can still be an arduous process to have to start over…
In addition, their annual contracts can also be greatly modified. MA Plan members could see coverage and benefit changes, cost-sharing amount modifications and premium fluctuations.
Unless you like potential surprises and restrictions, you may wish to consider getting Original Medicare and a good Medigap (Supplement) Policy. Then you can always know exactly what your premiums and out-of-pocket expenses (if any) would be. Plus it cannot be cancelled as long as premiums are paid.
Also, consider the health condition of the individual. A healthy individual could save money initially with a MA Plan due to lower premiums and fewer claims, but what about later in life? Or if currently in poor health? Then Original Medicare with a good supplement may be the way to go. The problem is that once you enroll in certain MA Plans, you can only switch plans under certain conditions. So think hard and plan ahead if at all possible – it could save you or your loved one a lot in the long run.
Find a Medicare Advantage Plan
Visit the Medicare Plan Finder at www.medicare.gov/find-a-plan to search for plans. For more information about overall plan ratings, visit www.medicare.gov/publications to view the fact sheet “Use Medicare’s Information on Quality to Help You Compare Plans.” You can also call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users should call 1‑877‑486‑2048.
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About the Author:
Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com