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Medicare Advantage Plans 101: How They Work and What They Cover

If you’re new to Medicare, you may be wondering what the different types of Medicare plans are and how they can help improve your quality of life. Fortunately, there are multiple options for those interested in exploring their coverage options after age 65. 

With so many people paying more attention to their personal finances these days, it is no wonder that more people are considering their options when it comes to choosing their Medicare coverage plan. 

This blog post will give you an overview of what Medicare Advantage plans are and what they offer before reaching out to a broker from the Big 65.

What Is a Medicare Advantage Plan?

A Medicare Advantage plan is a type of public health insurance for older persons and seniors that covers various medical services. It is a combination of traditional Medicare coverage and a private health insurance policy. 

Depending on your type of Medicare Advantage plan, your health insurance coverage will be combined with additional services and coverage that traditional Medicare does may not offer. 

Most Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). An HMO gives you access to a network of doctors and medical providers who agree to provide medical services at a discounted rate in exchange for being your primary source of healthcare. A PPO gives you access to a network of doctors and medical providers who charge you less if you use them as your primary source of healthcare.

How do Medicare Advantage Plans Work?

Advantage plans are unique because they are administered by private insurance providers and licensed by Medicare. Depending on the plan you choose, Advantage coverage may be a combination of Medicare Parts A and B and other private health insurance coverage. 

An Advantage plan can help cover out-of-pocket expenses that you might otherwise be responsible for under traditional Medicare alone. These include copayments, coinsurance, and deductibles. Depending on your chosen plan, you may also have access to prescription drug coverage, wellness visits, and hospice care. Advantage plans may have certain restrictions, such as a certain network of providers from whom you can receive care. 

You should verify that the plan you choose covers the services that you will need as you continue to get older.

Eligibility for Medicare Advantage Plans

Although you can generally enroll in Medicare at any time after age 65, you will automatically be enrolled in Original Medicare. This means that you will have access to Medicare Parts A and B while having no other additional coverage options. 

Advantage plans are not part of Original Medicare, so you will need to actively enroll in one of these plans and select a provider. You can enroll in an Advantage plan during the general enrollment period (GEP), which runs from October 15 to December 7 every year, or during a special enrollment period (SEP) if you experience a qualifying life event such as a job loss or the death of a spouse.

Final Words: Takeaway Lessons

After reading this post, you should better understand what Medicare Advantage plans are and how they differ from traditional Medicare coverage. Advantage plans offer you the opportunity to explore a wide range of coverage options and are beneficial for those who may have a special need for additional services. 

Traditional Medicare is a great option for seniors who have done the math and are confident that Medicare will cover all of their medical expenses. But for those who want additional coverage or who require specialized care like hospice, Advantage plans are an excellent choice.

Red Note: 3 June 2022

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