It is important to choose a Medicare Advantage plan with care because it will affect the healthcare services you are able to receive, the cost of those services, and your overall healthcare experience.
Medicare Advantage plans are an alternative to Original Medicare and are offered by private insurance companies that have been approved by Medicare. These plans typically offer a wider range of benefits than Original Medicare and may have lower out-of-pocket costs for the beneficiary.
However, each Medicare Advantage plan is different and it is important to carefully review the plan’s benefits and costs before enrolling to make sure it is the right fit for your healthcare needs and budget. Contact us at the Modern Medicare Agency if you’d like some help finding the plan that best fits you and your family.
Medicare Enrollment Periods
There are several enrollment periods for Medicare, which is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
The Initial Enrollment Period (IEP) is the first time you can enroll in Medicare. You are eligible for the IEP if you are 65 or older and a citizen or permanent resident of the United States. Your IEP begins three months before the month of your 65th birthday and ends three months after the month of your 65th birthday.
The General Enrollment Period (GEP) is for if you missed your IEP. You can enroll during the GEP, which is from January 1 to March 31 each year. If you enroll during the GEP, your coverage will begin on July 1 of that year.
The Special Enrollment Period (SEP) is for if you are already enrolled in Medicare. You may be able to enroll in a different Medicare plan during certain circumstances, such as if you move, lose your current coverage, or are no longer eligible for certain types of coverage.
It is important to note that if you do not enroll in Medicare when you are first eligible, you may have to pay a penalty when you do enroll so it is a good idea to enroll in Medicare as soon as you are eligible to avoid any potential penalties.
Medicare Advantage General Coverage
Medicare Advantage Plans (also known as Medicare Part C plans) are private health insurance plans that are approved by Medicare and offer additional benefits beyond Original Medicare (Medicare Part A and Part B). Medicare Advantage Plans must cover all of the benefits that Original Medicare covers, but they may also offer additional coverage, such as prescription drugs, vision, hearing, and dental services.
Most Medicare Advantage Plans offer a range of options, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs), and Medicare Medical Savings Account (MSA) Plans.
In general, Medicare Advantage Plans may cover:
- Hospital care (inpatient and outpatient)
- Medical care (doctor visits, lab tests, and other medical services)
- Prescription drugs
- Emergency and urgent care
- Preventive care (such as annual physicals and screenings)
- Vision and hearing services
- Dental services
- Fitness programs
It is important to note that coverage and costs can vary depending on the specific Medicare Advantage Plan you choose, however, all Medicare Advantage Plans have to cover everything that original Medicare covers and unlike original Medicare, Medicare Advantage plans will always have a maximum out of pocket, to prevent catastrophic medical bills.
Be sure to review the Summary of Benefits provided by the plan to understand what is covered and what is not covered.
How to choose a Medicare Advantage Plan
Here are some tips for choosing the best Medicare Advantage Plan for you:
- Determine your coverage needs: Consider your current and future health care needs when choosing a Medicare Advantage Plan. For example, if you have a chronic condition, you may want a plan that includes additional coverage for prescription drugs or medical equipment.
- Compare plan options: Compare the different Medicare Advantage Plans available in your area. You can use the Medicare Plan Finder tool on the Medicare website to compare plans based on your specific needs and preferences.
- Check the plan’s network: Make sure the plan you are considering has a network of providers (doctors, hospitals, etc.) that you are comfortable with.
- Consider the cost: Medicare Advantage Plans typically have premiums, deductibles, and copays or coinsurance. Consider the total cost of the plan, including any out-of-pocket expenses you may incur, to determine if it is a good fit for your budget.
- Read the plan’s summary of benefits: Each Medicare Advantage Plan must provide a Summary of Benefits that outlines what is covered and what is not covered. Review this document carefully to ensure that the plan meets your needs and budget.
- Enroll during the annual enrollment period: You can enroll in a Medicare Advantage Plan during the annual enrollment period, which runs from October 15 to December 7 each year. This is the best time to review your coverage and make any changes to your plan.
Remember, it is important to review your Medicare Advantage Plan annually to ensure that it continues to meet your needs.
Factors Influencing Medicare Costs
There are several factors that can affect the availability and cost of Medicare Advantage Plans. These include:
- Location: Medicare Advantage Plans are offered by private insurance companies and are only available in certain areas. The availability of plans may vary by region or state.
- Age: Medicare Advantage Plans may have different premium rates based on your age Medicare advantage plans never charge different rates due to age or sex Premiums may be higher for individuals who are older.
- Health status: Medicare advantage plans never have underwriting and always cover every consumer at the same rate. Health and age do not affect the premium.
- Income: All plans charged the same rates regardless of income. The only reason someone would receive a lower rate would be because they qualify for Medicaid or extra help programs.
- Type of plan: Different types of Medicare Advantage Plans may have different premium rates and coverage options. For example, Health Maintenance Organizations (HMOs) may have lower premiums but may have more restrictions on provider choice, while Preferred Provider Organizations (PPOs) may have higher premiums but more flexibility in choosing providers.
- Coverage needs: Your coverage needs can also affect the cost and availability of Medicare Advantage Plans. For example, if you need coverage for prescription drugs or additional benefits such as vision or dental care, you may have to pay more for a plan that includes these benefits.
It is important to consider these factors when choosing a Medicare Advantage Plan to ensure that you are getting the coverage and benefits that best meet your needs and budget.
Should active-duty or retired military personnel get TRICARE or Medicare?
It depends on the individual’s specific needs and circumstances. Both TRICARE and Medicare provide health insurance options for retired and active-duty military members, but they have different coverage options and costs.
TRICARE is a health care program for active duty and retired members of the military and their families, and is managed by the Defense Health Agency, an agency of the Department of Defense. It offers a wide range of coverage options, including medical, dental, and prescription drug coverage. It also provides some additional benefits such as coverage while traveling abroad. TRICARE is only available to eligible military personnel and their families.
Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. It provides coverage for hospital stays, doctor visits, and other medical expenses. Medicare is available to a broader population, but its benefits may be more limited than TRICARE.
If the member is eligible for both TRICARE and Medicare, generally, they must have Medicare Part A and Medicare Part B, and use TRICARE as their secondary insurance. Medicare typically pays first and TRICARE pays second, and any remaining costs would be the responsibility of the individual.
It’s worth noting that Medicare and TRICARE have different enrollment periods, different out-of-pocket costs, and different coverage options, so it’s important for retired or active-duty military members to compare the two programs and choose the one that best suits their needs. Consulting with a TRICARE or Medicare expert or the respective program’s customer service is highly recommended to make an informed decision.
The different TRICARE health care plans
TRICARE offers a variety of health care plans, including:
- TRICARE Prime: This is a managed care option that requires enrollees to choose a primary care manager and get referrals for specialty care.
- TRICARE Select: This is a fee-for-service option that allows enrollees to see any TRICARE-authorized provider without a referral.
- TRICARE For Life: This is a supplemental insurance plan for Medicare-eligible military retirees and their families.
- TRICARE Reserve Select: This is a premium-based health plan for members of the Reserve and National Guard who are not on active duty.
- TRICARE Young Adult: This is a health care plan for adult children of military sponsors who are no longer eligible for TRICARE coverage as a dependent child.
TRICARE also offers a number of other programs and services, including pharmacy benefits, mental health care, and dental coverage.
Final take
If you’re still unsure about any of this or simply need additional advice according to your needs, chat to a friendly Medicare Advantage agent near me so that you have all the information you need to make the right decision for you and your family.