Medicare Advantage Moves Coverage From Government to Private Carriers; Check Benefit/Cost Before Switching

Medicare recipients were encouraged when the federal government modified Medicare procedures to allow private competition with Medicare Advantage plans.

Unfortunately, the change also generated a great deal confusion on the part of the industry as well as with consumers.  In many cases people enrolling in these plans didn’t fully understand the wide array of coverage options as well as limitations and exclusions contained within them. 
As a result, some benefited by enrolling in the new plans while others did not. The most common Medicare Advantage plans are: Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPO’s), and Private-Fee-for-Service Plans (PFFS).

While HMO and PPO plans generally limit the enrollee to healthcare providers in their network, PFFS plans do not restrict to a network. Any healthcare provider willing to accept the plan’s payment terms and conditions can be used. This includes hospitals, doctors, dentists and any healthcare providers.

To sign up for an Advantage plan with any provider, you must have Medicare Part A and Part B and you will still have to pay your monthly Medicare Part B premium. 

You may also have to pay a monthly premium to your Advantage Plan, depending upon the coverage you choose.  Premiums are often less costly than a standardized medicare supplement policy.

Here are several key factors to consider before enrolling:

• Check to see if your current providers (Doctors and Hospitals) participate in the plan.  If they do not, you may have to change providers or see if they are willing to join.
• If you plan to relocate, make sure the plan is offered in your new location.  Be aware that your premiums could change as a result, since premiums for Medicare Advantage products vary based on state and county of residence.
• Check your “out of pocket” costs under the new plan.  Most plans have deductibles, co-payments, and co-insurance amounts that you must pay.  Depending on your situation, out-of-pocket expenses with an advantage plan may differ from cost under the original Medicare combined with a Medicare Supplement policy.  Advantage plans may also offer benefits not covered under original Medicare such as health/wellness education, routine physicals, dental, hearing, and vision services.  Compare these benefits against additional costs.
• Only consider plans offered by insurance carriers with superior financial strength and a reputation for stability.  Although, there are no guarantees, these carriers are more likely stay in the Medicare marketplace in future years.