Who Should Enrol in a Medicare Advantage Plan?

Who Should Enroll in a Medicare Advantage Plan?

There are many people who chose to enrol in a Medicare Advantage plan, sometimes referred to as a MA plan. A Medicare Advantage plan is a private health insurance programme that can provide additional benefits compared to an Original Medicare plan.

The Original Medicare plan covers:

Part A

This pays for all in-hospital service costs, excluding surgeons and physicians.

Part B

Covers physicians and surgeons costs, and any out-patient treatments that may be required. This can include X-Rays, ER visits, laboratory and diagnostic tests which may have to be carried out.

The Medicare Advantage plan is also called “Part C” due to the additional benefits that you can obtain through the plan. Should you also choose a Medicare Advantage plan that includes “Part D,” this is a prescription drug benefit plan. In such cases, they are referred to as a Medicare Advantage Prescription Drug (MAPD) plan.

You should also be aware of medicare plan hidden risks.

To Enroll in a Medicare Advantage Plan:

  • You must live in the service area that the plan that you choose to enrol in covers. If you live or work in another state for part of the year, it is important to find out if the plan will continue to provide you with cover.
  • You must already have a health insurance plan that includes Part A and Part B
  • You may NOT suffer from End-Stage Renal Disease (ESRD)

You can only enrol in a Medicare Advantage plan during particular times of the year. As these plans are provided by private health insurance companies, the benefits and cost-sharing payments will vary.

Who Should Enrol in a Medicare Advantage Plan?

There are 4 Main Types of Medicare Advantage Plans:

  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3. Private Fee-For-Service (PFFS)
  4. Special Needs Plans (SNP)

When looking for a Medicare Advantage plan you can find some that provide additional benefits for health care with regards to:

  • Vision
  • Dental
  • Hearing
  • Health and wellness programs

A Medicare Advantage plan is an annual contract that you have arranged with the health insurance provider that you have chosen. Therefore it is important to check each year in case there are any changes to the policy. This could include the network of health care providers, the copayments that you may be required to make, or the list of prescription drugs that may be covered.

Another factor when enrolling in a Medicare Advantage plan is to be aware that any hospice care will not be covered in the policy. Hospice care will however be covered within the Original Medicare plan, even if you have a Medicare Advantage plan.

You can also find yourself covered for emergency and urgent care costs with a Medicare Advantage plan. This can prove to be an important factor for many senior members of the community, providing them with some peace of mind should their health care needs require it.

As a Medicare Advantage plan is not an alternative to the Original Medicare plan, it is vital that you continue paying your monthly Part B premium. All other costs and cover are included in one through your Medicare Advantage plan.

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