Medicare has been one of the most helpful ways of obtaining health coverage for those approaching retirement. But it only covers so much for its beneficiaries. Medicare Parts A and B (otherwise known as Original Medicare) covers hospital expenses and doctors’ expenses such as screenings and lab work, respectively. However, Original Medicare provides no coverage for prescription drugs, and beneficiaries are liable for 20% of all of their expenses for life. There is no cap to how much a beneficiary spends out of pocket and there is no coverage for prescription drugs. For most people reaching retirement, this type of health care can add up to exorbitant costs. Luckily, Medicare Advantage is an option that beneficiaries can take advantage of to limit how much they spend out of their own pockets for medical services.
Medicare Advantage plans are also known as Part C plans. They are provided by a private insurance company that is paid by Medicare to manage the beneficiary’s health care benefits. So the beneficiary would still have Original Medicare, but it would be their secondary plan while the Medicare Advantage is their primary plan. While the beneficiary is still required to pay the $135.50 2019 premium for Medicare Part B, some Medicare Advantage plans have a $0 monthly premium. Premium costs, copays and coinsurances do vary depending on the plan, but the out of pocket maximum would be no more than $6,700 in a year. Once that limit is hit, all covered expenses are paid for by the plan.
Beneficiaries can choose to enroll in a Medicare Part D plan to obtain coverage for their prescription drugs. The average monthly premium for Part D is $33.50, but around 82% of Medicare Advantage plans include prescription drug coverage.
There are different coverage options offered under Medicare Advantage Plans. They include:
-Special needs plans
Most Medicare Advantage plans are either HMO’s or PPO’s. Under an HMO (Health Maintenance Organization) beneficiaries are restricted to staying within the plan’s network to get coverage for certain services. With a PPO (Preferred Provider Organization) plans will allow the beneficiary to see a specialist without a referral. If beneficiaries seek maximum flexibility when it comes to receiving a medical service, the an Advantage Plan is the best option.
If you have questions or are confused about what you will be liable for, book a meeting with an agent. The goal is to lower your potential cost as low as possible while still receiving great medical care when you need it and give you peace of mind.