You may be eligible for Medicare benefits, or you are approaching eligibility and you have heard about Medicare Advantage plans. It is important to know Medicare Advantage plans do not replace Original Medicare but rather work with Original Medicare. Original Medicare is divided into Part A (hospital insurance) and Part B (outpatient insurance). Once you have Original Medicare you can look for Medicare Advantage plans to help supplement your cost of care.
Medicare Advantage is offered through private insurance carriers. These private carriers offer Medicare Advantage plans and must cover at least what is covered by Original Medicare. When you start looking at Medicare Advantage plans you will want to know your county of residence. Medicare does go by county so the same would go for your Medicare Advantage plan. This is important because not all carriers have plans in all counties.
Now that you know what county you reside in, and the carriers available in your county, you can look at your plan options. Minnesota does have a couple Part C options available in some counties. You may have the option for Medicare Advantage and Medicare Cost plan. Medicare Advantage plans include prescription coverage in the plan. Medicare Cost plans may have a plan with or without prescription coverage. For the sake of this article, we are going to focus on Medicare Advantage plans.
Different levels of plans
As mentioned earlier, Medicare Advantage plans are offered through private insurance carriers. Each carrier will offer different levels of premium. You will typically see a premium around $0 a month, another around $50 a month, and another around $100 a month. There may be more options available, but for the sake of the article and focusing on the difference between Medicare Advantage plans available we will focus on these three levels. Even the lowest premium plan will still cover all of what Original Medicare covers, but different levels of plans will have different offerings. Medicare Advantage plans have Maximum Out Of Pocket (MOOP) which we will also discus at these different levels.
Let’s look at the lowest premium, around $0:
Considering you have a lower premium, you will expect to have more out of pocket when you use services. For example, you need to see a doctor because you are not feeling well. You would have a higher copay or coinsurance up front to see that doctor. At the lower premium level there will be a higher MOOP.
Now, looking at the middle premium, around $50:
At this level you can still expect a little more out of pocket, just not as much as you would at the lowest premium level. What you may see at this level is the removal of co-insurance and a copay in its place. A benefit of this level is knowing what dollar amount you will pay for services rather than a percentage of the amount billed from the provider. At this level you would also see a little lower MOOP.
Now, looking at the higher premium of around $100:
Now you are paying more monthly for your premium. You are probably expecting more coverage. What you can expect is lower co-insurance and copays for your visits. You will also see lower MOOP because you are paying a little higher monthly premium.
When comparing the different Medicare Advantage plan levels, you will want to look at your provider network. Keystone Insurance can help you look at networks to make sure your provider(s) are in the network you are considering. Private insurance carriers have agreements with providers which can lead to some providers not being in the lower premium network. Having a higher premium plan may provide a larger network. In addition to comparing between the premium. Some carriers also have a limited network outside of Minnesota, so it is important to take travel within the United States into consideration when looking at plans.
Prescription coverage can also range between plans. Just like with other coverage, you may have higher copays and co-insurance for prescriptions. You may also see higher deductibles with the lower premium plan as well. Just like the insurance companies negotiate with providers for health coverage, they also negotiate with pharmacies pertaining to formularies and how prescriptions are covered. With the lower premium plan, you may find less prescriptions covered in the formulary.
Most Medicare Advantage plans also include supplemental benefits like fitness memberships, vision coverage and dental coverage. Higher premium plans tend to include more coverage with dental and vision. For example, the higher premium may come with preventative and comprehensive coverage for dental versus the lower premium including coverage for preventative only.
There are many differences in Medicare Advantage plans and deciding on the right plans can be difficult. Contact Keystone Insurance to help you sort out the differences and help you find a plan best for your needs.