As seniors find out all too often, Medicare doesn’t cover everything, and what it does cover can still wind up being expensive with copays and deductibles. One way to reduce medical costs is to manage these expenses better, and that is the focus of Medicare Advantage.
What Does Medicare Advantage Give You?
A Medicare Advantage plan gives you all the coverage of Medicare, including Part A and Part B benefits, plus coverage for services not covered under basic Medicare, such as prescription drugs and custodial care. Other services that a managed care plan may provide that basic Medicare does not, include eye exams, chiropractic care, and hearing aids.
You Need to Be Careful Considering Medicare Advantage Plans
There are some disadvantages to managed health care, however, that you need to consider when making your health plans. Managed health care providers make money by keeping costs down. The plans discourage unnecessary services, and promote preventive medicine. Many are HMO or PPO plans where the choices you can make for doctors and clinics to receive treatment are limited to those the plan has contracted with for specific fees. If you go out of network, neither the plan nor Medicare will pay the bill. Most will require a primary physician to refer you to specialists, except in certain serious situations. Some plans are not as restrictive, but will require higher portions of the bill to be paid by you than if you remained in-network, or may have higher premiums. So, you will need to be sure there are in-network doctors and clinics in your area that cover treatment you may need. You also may find when you travel, you’ll possibly have to pay out-of-network fees. You should also keep in mind that even if your doctor of choice is in-network, it doesn’t mean that he or she will always stay with the plan, and you may have to change doctors to remain in-network.
Medicare Advantage Is Not for Everyone
You need to consider your medical requirements, what physicians and specialists you may need, and whether the advantage of wider services and lower out of pocket expense outweighs the potential disadvantages. There are several different Medicare Advantage programs, so if it is suitable for your needs, you will need to research which plan gives you the greatest benefit.
Contact an insurance specialist to go over the plans with you and help you discover what will work best for you as you approach Medicare eligibility.