Medicare Advantage (also known as Medicare Part C) is an alternative way for individuals to receive Medicare benefits.
Medicare Advantage provides at least the same level of coverage as Medicare Part A and Medicare Part B, but unlike Original Medicare, Medicare Advantage is offered by private insurance companies.
When you become eligible for Medicare, you’ll probably wonder whether Original Medicare or Medicare Advantage is the better choice. The truth is, the best option for you depends on your personal preferences.
Medicare Advantage plans often come with additional benefits that aren’t included under Original Medicare. The benefits range from insurer to insurer but can include routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership.
Depending on your lifestyle, these benefits might be extremely appealing or might not match your personal preference.
All qualified Medicare Advantage Plans are required to provide at least the same coverage as Original Medicare Parts A and B. This means that you are guaranteed to have the essentials covered, no matter which plan you choose.
Aside from the minimum coverage, there are quite a few differences between Original Medicare and Medicare Advantage Plans. Where Medicare Advantage plans differ and have the edge over Original Medicare is in the fact that they offer more benefits/coverage.
The following are important areas in which Medicare Advantage plans offer you more than the Original Medicare option:
Under Original Medicare, Part A covers medical and Part B covers hospital costs. In addition to the medical and hospital costs, Medicare Advantage plans offer dental insurance, prescription drugs, hearing and vision coverage, and more.
Medicare Advantage enrollees must continue to pay the Part B premium alongside the Medicare Advantage plan premium (determined by the insurer). This MA premium varies from one plan to another, and some may have premiums as low as $0.
In terms of out-of-pocket costs, Medicare Advantage plans limit how much you spend in a year. Once you reach the cap maximum, the insurer will usually pay 100% for covered services. However, Original Medicare has no cap on out-of-pocket costs, so your potential expenses are limitless.
Often a Medicare Advantage plan can be less expensive than comparable coverage under Original Medicare.
Original Medicare does not include coverage outside of the country, even if it is an emergency. Certain Medicare Advantage plans do cover you if you travel outside the country.
Original Medicare covers the first 80% of the cost, you are then responsible for the remaining 20% of the bill for things like doctor office visits, outpatient surgery, and other basic medical services. With a Medicare Advantage Plan, you pay a fixed copayment.
With Original Medicare, you have the choice of any provider or facility which accepts Medicare. Depending on the type of plan you choose, Medicare Advantage plans will usually have a closed network or a preferred network of providers.
With the Medicare enrollment periods approaching, information regarding the 2021 changes has been released.
In 2021, enrollees can expect three big changes, including the expansion of telehealth services and coverage, long-term care coverage, and more coverage options for people with end-stage renal disease.
If you are one of the 24 million Americans enrolled in Medicare Advantage plans, it is important to be familiar with the upcoming changes so that you can make an informed decision when it’s time to re-enroll or switch plans.
Here are some of the changes seniors and caregivers need to know about the 2021 changes.
Medicare Advantage plans will increase telehealth services and coverage. Telehealth allows seniors to be treated by medical professionals without leaving the safety of their home – particularly helpful to those who live far from a doctor’s office or high-risk individuals who need to limit exposure to disease.
Medicare Advantage plans will include telehealth providers in certain practice areas, including:
Medicare Advantage plans currently cover skilled services or rehabilitative care for up to 100 days. They also include benefits for supplemental home care services for chronically ill beneficiaries.
Starting in 2021, Medicare Advantage plans will cover various supplemental home care services, including adult day care services, in-home personal care services, over-the-counter product benefits, home safety modifications, meal delivery, and transportation.
The introduction of these new benefits will make a significant difference to those receiving care at home, although coverage will vary by plan and location.
In 2021, the 21st Century Cures Act will allow individuals with end-stage renal disease (ESRD) to choose a Medicare Advantage plan regardless of their previous coverage. Previously, individuals with ESRD could only enroll in Medicare Advantage plans under limited circumstances.
CMS estimates that over 80,000 additional people with ESRD will enroll in Medicare Advantage by 2026 – an increase of 63%.
The term “donut hole” refers to the gap in Medicare Part D coverage where you pay more for prescription drugs. Since 2011, measures have been put in place to close the donut hole.
Once you reach your initial coverage limit, you’ll enter the donut hole and need to pay a percentage until you’ve reached the out of pocket (OOP) threshold.
In 2021, the initial coverage limit is $4,130, up from $4,020 in 2020, making it harder to reach the donut hole. If you do reach the donut hole of Medicare Part D in 2021, discounts for brand name and generic drugs are 75%.
Before you enroll in the first Medicare Advantage plan you stumble across, it’s important to familiarize yourself with all the available options.
Not only do Medicare Advantage plans vary in terms of premiums, out-of-pocket costs, and network, plans also come with different benefits. A Medicare Advantage plan that works for you is likely to be the polar opposite for your neighbour.
If you are looking to enroll in a plan in 2021, there are many great options. Medicare Advantage plans are more popular than ever, with seniors across America realizing how economical the plans can be.
Medicare Advantage plans are available through major carriers, including United Healthcare, Aetna, Cigna, Anthem, Humana, and others.
Our licensed agents will guide you through all of the insurance providers in your area and give you an idea of the benefits and cost you can expect. We will help you find a plan that offers you expansive coverage that takes care of your health and leaves you with minimal out-of-pocket costs.
Medicare requires that you only make changes to your coverage during pre-determined enrollment periods. It isn’t possible to change your enrollment status at any time, and before you can enroll in Medicare Advantage, you must first be enrolled in Original Medicare (Part A and B).
Once you find a Medicare Advantage, you can apply during designated enrollment periods.
You are granted an Initial Enrollment Period when you first become eligible for Medicare. Your Initial Enrollment Period begins three months before you turn 65, includes the month of your birthday and continues for three months after – totaling seven months.
The Annual Enrollment Period (sometimes called the Fall Medicare Open Enrollment Period) runs from October 15 to December 7. During this period, individuals enrolled in Original Medicare can enroll in a Medicare Advantage plan.
The Special Enrollment Period has no set beginning or end date. The period is available to individuals who experience qualifying life events, such as moving state and losing employee health coverage. Such life events give you a window of up to eight months.
Medicare Advantage 2021 enrollment is coming up soon. Being fully informed is the first step in knowing your options. Make sure to consult with a Licensed Insurance Agent to be guided in finding the best plan for you.
If you are currently enrolled in a Medicare Advantage Plan but want to switch to Original Medicare or a different Medicare Advantage plan, you can do so during the Medicare Advantage Open Enrollment Period.
The Medicare Advantage Open Enrollment Period begins on January 1 and ends March 31.
Throughout this period, Medicare Advantage plan enrollees can switch to an alternative Medicare Advantage Plan, re-enroll in Original Medicare, and sign up for a Part D Prescription Drug plan.
You can return to Original Medicare regardless of how long you have been enrolled in a plan. It is possible to enroll during the Annual Election Period and revert back to Original Medicare, during the following Open Enrollment Period.
If you have been a Medicare enrollee for many years, you might remember the Medicare Advantage Disenrollment Period (MADP). The MADP was replaced by the Medicare Advantage Open Enrollment Period in 2019.
Individuals would previously be able to disenroll from Medicare Advantage and return to Original Medicare between January 1 and February 14. The introduction of the Medicare Advantage Open Enrollment Period has created a bigger time window (January 1 and March 31).
Medicare Advantage 2021 enrollment is coming soon. Make sure to consult with a licensed insurance agent to be guided in finding the best plan for you. Get in touch with our team today to find a plan that matches your needs. Call us on 1-855-810-430.