The Benefits of Medicare Advantage

When you turn 65, you’ll most likely begin getting health coverage through a government program called Medicare. That includes Medicare Part A (hospital benefits) and Medicare Part B (medical insurance benefits). You might see that combination called Original Medicare. You’ll have to pay extra for a prescription drug plan (Medicare Part D), and you won’t be covered for dental, vision, or hearing, in most cases.

Some good news: You have options. For instance, you can reap the benefits of Medicare Advantage, also called Medicare Part C, which offers similar health benefits to Original Medicare. However, it is offered through a private insurance company, and Medicare Advantage plans may offer additional benefits such as dental, vision, and hearing coverage.

When HealthMarkets’ licensed insurance agent, Jon Jacobi first opened his Omaha, Nebraska, agency 16 years ago, most of his older adult clients chose Original Medicare with a Medicare Supplement Insurance plan. But he’s noticed a big shift since then. He says that about two-thirds of clients now choose a Medicare Advantage plan. “Medicare Advantage is now the preferred choice,” says Jacobi. “That doesn’t mean it’s the right one for everyone, but if you haven’t reviewed the benefits lately, you may want to look again.”

Answering the following questions can help you determine whether Medicare Advantage may be the right choice for you.

Do you have questions and want help understanding Medicare? Call a licensed insurance agent at (800) 827-9990.

1. Do I need prescription drug coverage, and can I get that benefit through Medicare Advantage?

If you take prescription medications, Medicare Advantage plans may be a more cost-effective choice than Original Medicare, says Jacobi. Medicare Parts A and B do not cover prescription drugs. In order to do that, you’ll need to pay for a stand-alone plan called Medicare Part D, which covers prescription drugs.

Some good news: Most Medicare Advantage plans can also include Part D coverage.

Medicare Part D premiums vary by plan. If you have a lower income and need drug coverage, Part D may still be the way to go, Jacobi says. You can also call a licensed insurance agent at (800) 827-9990 to discuss your coverage questions.

2. Do I want vision, hearing, dental, or wellness plan services?

If you want additional benefits, like vision, hearing, dental, or gym memberships, you may want to consider Medicare Advantage. (Original Medicare doesn’t offer those optional benefits.) “With Medicare Advantage, there’s a whole gamut of value-added benefits, so you’ll be seeing additional savings as these wellness services add up,” he says. Additional benefits can include:

• Acupuncture
• Chiropractic services
• Dental, vision, and hearing (hearing aids)
• Gym memberships
• Transportation

And that’s just the tip of the iceberg.

Alternatively, you can add more coverage to your Original Medicare plan instead of having a single Medicare Advantage plan. For example:

• You can add Part D for prescription drug coverage.
• And if you want a vision, dental, and hearing coverage, you can purchase supplemental plans.
• You can also choose Medigap (aka Medicare Supplement Insurance), which helps pay for things like deductibles, copayments and coinsurance.

3. Do I want a cap on out-of-pocket expenditures?

Original Medicare doesn’t have an out-of-pocket spending maximum. That means your copayments or coinsurance can continue to add up with no limit. However, a Medicare Advantage plan does have an out-of-pocket spending cap. For 2022, the out-of-pocket limit for these plans is $7,550.

“If you are a low to moderate utilizer of health care, Medicare Advantage is an attractive choice,” says Jacobi. “But if you are a high utilizer of health care, Original Medicare with [Medigap] may be the better option.”

4. Do I get good network coverage?

If you go with Original Medicare, Medigap may be a convenient choice because you won’t have to use certain health care networks or get referrals for specialists. Plus, there’s no service-area restrictions. But if you choose Medicare Advantage, you may have to pick doctors within that plan’s network. You may also need to get prior approval to get certain prescription drugs or services.

But a Medicare Advantage plan may offer you more freedom than you think, says Jacobi. Because the plan is always expanding, you could have much more coverage than you would have even just a few years ago, he suggests.

Need some help? Call a licensed insurance agent at (800) 827-9990, or visit us online today.

5. Would I rather have copayments or coinsurance?

Original Medicare charges a 20% coinsurance for most services. That means you’ll pay 20% of the cost of health services, and usually, your insurance company will pay the other 80%. But Medicare Advantage plans, which can be through health maintenance organizations (HMOs) or preferred provider organizations (PPOs), structure your costs differently. They can offer copayments — fixed amounts you pay every time you get health services.

Bottom line: Once you turn 65, you have options besides just Original Medicare. One of them can be Medicare Advantage. Need some help understanding the difference between Original Medicare and Medicare Advantage? Call a licensed insurance agent at (800) 827-9990, or visit us online today.