Medicare Advantage
Since their establishment in 1997, Medicare Advantage plans have gained traction and popularity and now, 50% of Medicare beneficiaries are enrolled in advantage plans, that’s up from 25% in 2010. Advantage plans have contracts with Medicare, and are rated by Medicare to be at least as good as Original Medicare. I could write a book about Medicare Advantage, but will briefly summarize the key points.
The plan you enroll in becomes your primary insurance covering parts A, B, and D all in one.
Once enrolled, you follow the rules of that plan and the set copays for medical services (ex. $0 monthly premium, $40 specialist copay, $300 per day hospital stay, $15 chiropractor visit, etc).
Which plans are available depends on which county you live in, some counties have better plans than others.
Providers can either be in-network or out-of-network with a given advantage plan. On HMO plans, except for emergencies, you get services from only in-network providers. On PPO plans, you can go to both in-network and out-of-network providers (for a higher copay).
Advantage plans come with perks like dental, vision, and hearing coverage, which is not covered by Original Medicare. These plans usually also come with gym memberships, rewards programs, and sometimes over-the-counter allowances, medical transportation, and social security “giveback” programs.
All counties in NY now offer solid advantage plans, and these usually save members money over the course of the year. The exception to that is those with comprehensive and and frequent medical needs, in which case the Medicare Supplement is the way to go. To go back to my analogy, the Medsupp is like buying into a buffet, you pay a big price upfront, but after that everything is “free.” The advantage plan is like ordering off the menu, and paying for what you get. Advantage plans do put maximum-out-of-pocket limits on their plans, usually around $7,000 per year, so they are still protected from worst case scenarios.
As I said at the beginning, I could go on about MAPDs forever, but for personalized advise, call your local agent.
