Turning 65 can be a bit overwhelming. As the years have passed, I’ve learned one undeniable fact: we have 65 years to learn about Medicare, but no one thinks about it until they are 64 and 9 months old. If you’re about to turn 65, you’re already 65, or you’re older than 65 – and trying to learn more about Medicare options by reading this blog, you’re already ahead of the game.
By visiting our site and looking over our blogs, you would have done more research about your options than most Medicare beneficiaries. Our purpose here is to help you – the beneficiary – understand why some people choose Medicare Advantage plans over Medicare Supplement, or continue with Traditional Medicare along with a Stand-Alone Prescription Drug Plan. For more information on Medicare Supplement and Stand-Alone Prescription Drug Plans, we encourage you to refer to our other blogs.
What is Medicare Advantage?
A Medicare Advantage Plan or (MA), also known as Part C, is one way to choose how to receive your Medicare benefits. When you have a MA, you still have Medicare – it is just being coordinated by a Private Company. It is very important to keep in mind that MA Plans cover all the benefits of Original Medicare and can also include additional benefits. These additional benefits are what we are covering today as reasons why people choose to have MA plans.
Reasons to Choose a Medicare Advantage Plan
The first reason to choose a Medicare Advantage Plan is to have an all-in-one plan that includes prescription drug coverage. An important fact to state here is that Original Medicare alone does not cover Prescription Drugs. Therefore, to get Prescription Drug coverage, you need to purchase a Stand Alone Prescription Drug Plan, known as a PDP, or have the coverage included in your Medicare Advantage benefits. Medicare Advantage plans with Drug Coverage are known as MAPDs. Most Medicare Advantage plans have a prescription drug plan embedded into them at no additional monthly cost, even if that monthly premium is $0.
The second reason to choose a Medicare Advantage plan is to avoid Original Medicare deductibles. Part A(Hospital) and PartB (Medical) have their own annual deductibles. For the year 2020, the Part A annual deductible is $1,400, and the Part B annual deductible is $190.Most Medicare Advantage plans do not have a deductible – rather, they have copays. An individual could expect to pay anywhere between $20 and $50 to see a specialist.
The third reason to choose a Medicare Advantage plan is for the benefit of a Maximum Out-of-Pocket Limit to your healthcare costs. This is an added benefit that Original Medicare alone does offer. Having a Maximum Out-of-Pocket is important due to the fact that once you reach this dollar amount in copays, you are done paying for any medically necessary procedures or office visits. Any remaining copays will be covered by the private company that is coordinating the Medicare Advantage Plan. An easy way to understand this is to imagine a bucketthat fills as you go through the year paying copay. When you reach your maximum out-of-pocket, the bucket is considered full and you are not responsible for any more medical-related out-of-pocket expenses for the rest of the calendar year.
The fourth reason to choose a Medicare Advantage plan is have set copays rather than 20% co-insurance that you have with Original Medicare. Up on reviewing your Medicare Advantage options, you will notice that each plan has its own specific copays that would be required to be paid for each service. Copays can be as low as $0, depending on your plan options in your area. This is a benefit that Traditional Medicare does not offer. At Texas Medicare Solutions, before you sign up for a plan, we, as Agents, go through what is called the Summary of Benefits with you. The Summary of Benefits will state each copay associated with each service. Every carrier chooses their copays each year, and may choose to raise or lower them. This is why it is important to review your Medicare Advantage plan annually.
The fifth reason to choose a Medicare Advantage plan is for the additional benefits. Depending on your service area (the county you live in), your Medicare Advantage options may have additional benefits, such as Dental, Hearing, Vision, Transportation, Meal Benefits, Gym Memberships, and Over-the-Counter Benefits, just to name a few. Each Medicare Advantage company offers different additional benefits for each of their plans in the areas they serve. When going through your Medicare Advantage options, it is important to prioritize the benefits that are most important to you. At Texas Medicare Solutions, we welcome our clients to call us for help with utilizing any of your extra benefits.
If you’re shopping for a Medicare Advantage plan and would like assistance in doing that, feel free to contact our office at 210-908-6565. We serve the San Antonio Area and all of Texas.