Medicare Advantage Plans

The insurance enterprise is a steadily growing industry. Medicare Advantage plans are very prominent, but often are confusing. Medicare Advantage plans are a different method used by Medicare-approved insurance companies for individuals to receive their Medicare benefits. In order to be eligible for a Medicare Advantage plan, you have to be a recipient of Medicare Part A and Medicare Part B. Medicare Part A is hospital insurance. Medicare Part B is medical insurance. Many elderly individuals are using the Best Medicare Advantage Plans because there are more added benefits which are obsolete from the “original Medicare” plan. All HMO plans, under Medicare Advantage, have a annual limit on your out-of-pocket costs that cannot be exceeded. This limit protects the insured from extra expenses if more tests or treatments are needed. Medical researchers reported in 2019 the maximum out-of-pocket allotment for HMO plans was roughly $6,500. However, HMO plans may set a lower maximum-out-of-pocket threshold.

This plan offers the same benefits and protection as the Original Medicare but different restrictions and cost may apply. This plan is paid by the federal government so that Medicare benefits can be administered. Some HMO Plans offer dental and hearing services, but most do not offer these services. In order to join an HMO plan, you must already have Medicare Part A and Part B. The insured will be responsible for paying their
Medicare Part B premium, unless the HMO plan agrees to split the cost of the premium. HMOs plan require you to seek health services from in-network providers for coverage, unless emergency assistance is needed. Some HMO Plans allow you to use out-of-network doctors for health services, but your out of pocket expenses will be greater. Also, if you choose to use an out-of-network doctor a prior authorization or referral is not needed, but you will incur more expenses.

A key factor for an HMO plan is that the insurance providers cannot charge more than Original Medicare charges for chemotherapy, dialysis, and skilled nursing facility (SNF) care. In the contrary, HMO may charge higher copayments for service such as, but not limited to : medical equipment, home health and inpatient hospital service. In addition, If you want prescription drug coverage (Part D), you must make sure this feature is included in your HMO plan. You cannot enroll in Part D prescription coverage plan solely, unless you have a Medical Savings Account (MSA) or Private Fee-for-Service (PFFS) plan that does not offer prescription drug coverage.

The main difference from a PPO plan and an HMO plan, is a PPO sets 2 limits on the out-of-pocket expenses. Let’s look at an example. Let’s say your Medicare Advantage PPO plan has an out-of-pocket spending limit of $2,000 for in-network expenses and an out-of-pocket limit of $6,000 for your combined in-network and out-of-network expenses. You can reach the combined limit by spending $2,000 on in-network services and $4000 on out-of-network services, or by spending $6000 solely on out-of-network services. The benefit of having 2 limits on the out-of-pocket expenses is not just to save money, but to protect you from uncontrollable events that often happen in life. PPO Plans offer vision and dental annual screenings, as well as hearing services.

The sole purpose of this plan is to determine how much it will pay doctors, healthcare providers and hospitals, as well as determine your copayments for the aforesaid services. This plan allows you to obtain service from any Medicare-approved doctor that will accept the terms and conditions of the plan. Most PFFS plans have a set contract with certain providers who will agree to provide services to you even if they are not your primary care physician. Moreover, no referral is needed to see a specialist. This plan is designed to offer extensive medical services at a low price.

The aforementioned Medicare Advantage plans are simply the most common plans, but not the only plans available. For example, Medicare recipients may be interested in the Medicare Medical Savings Account, or MSA plan. This plan has a high deductible health plan (HDHP) and provides the insured with a bank account. In order to receive health coverage, you must meet a high deductible amount. This high deductible health plan requires the insured to pay for most of their health services upfront until the deductible has been reached for the year. Once the deductible is met, this plan will pay for all your medical expenses for the year. The bank account provided by this plan is strictly used for the plan to deposit funds once a year for all medical expenses. The funds can be used to pay for your deductible. No outside deposits can be made into this banking account. Generally speaking, the plans monetary contribution will be lower than the amount of the deductible. Remember as long as the money deposited into your MSA plan is used on qualified medical expenses, the funds are not taxed.

Due to the steadily rising need for health insurance, many private insurance companies offer various types of Medicare Advantage Plans. Let’s discuss the top-rated insurance companies for Medicare Advantage plans.