About Medicare Advantage Plans
There are a lot of advantages to Medicare Advantage. How do we know this? Well, it’s right there in the name. After all, they couldn’t call it Medicare Advantage unless there were advantages any more than they could call it Best Mayonnaise unless it was the best mayonnaise or Speedy Auto Glass unless they were really speedy.
You’ll notice there are very few such names in the medical world such as Best Colonoscopies or Speedy Open Heart Surgery. But that’s another matter.
With Medicare Advantage, there truly are pluses over Original Medicare although it cuts the other way, too. Suffice it to say, Original Medicare is right for some people and Medicare Advantage is a better choice for others.
With that said, some of the Advantages of Medicare Advantage over Original Medicare are:
1. You very often do not pay any premium at all for your Medicare Advantage plan. Free is a good thing, right? There are, however, some plans you do pay for, particularly those outside the urban areas where it is much harder for plans to put together an affordable doctor network.
2. With Medicare Advantage your prescription drug coverage is almost always included. On the other hand, with Original Medicare, you will have to pay for a stand-alone Prescription Drug Plan separately. Plus stand-alone Prescription Drug Plans almost always have deductibles such as $445 on Tier 3 and above drugs, whereas with Medicare Advantage plans there are usually no prescription drug deductibles and if they do have one it is generally a lesser amount.
3. Medicare Advantage plans usually include extras that you do not get with Original Medicare. Some of those added benefits can include:
1) Dental coverage: Most plans offer free preventative dental coverage including exams, cleanings and x-rays. Some plans take it a step further by giving you an amount that’s usually in the $1,000 to $2,000 range that you can use for any type of dental need at all, other than for cosmetic. It’s great news, right, when we can finally have that root canal we’ve so looked forward to. With Original Medicare dental plans can be bought privately for $30 to $50 a month but with Medicare Advantage it’s usually an included benefit.
2) Vision: Plans almost always include a free eye exam and money towards glasses each year typically around $200. You may not be able to buy your eyeglasses for $200 but it’s a good start. With Original Medicare, you can buy vision coverage privately but benefits are skimpy.
Note: The Medicare Advantage vision coverage perk is for an eye exam and for eye glasses. If you need to see an ophthalmologist, a medical doctor who specializes in eyes, this will be covered with any Medicare plan the same way as any medical specialist is. As long as an actual doctor is involved, an eye is no different than an elbow. So your cataract operation or glaucoma needs are covered by any Medicare plan you choose.
3) Hearing: Medicare Advantage plans often offer an annual free hearing exam along with money towards hearing aids as an extra perk for joining their plan. Some plans give you an amount towards hearing aids, such as $1,000 per ear, and let you select your own. Other plans pre-select levels of hearing aids and then the plan pays the lion share of their cost with you contributing a copay.
Hearing, like dental and vision, is not covered by Original Medicare. Separate private insurance coverage for hearing benefits is very difficult to obtain because hearing aids are expensive and insurance companies are smart enough to figure out that anyone who would buy a hearing policy would have hearing issues and therefore use it.
4) Over the Counter Products: Most plans give you an amount of money that could range from $40 to $100 every three months that you are able to spend on products from their catalog that are shipped to you, all for free. Items include every type of over-the-counter medicine, a full range of vitamins, bandages, even toothpaste and electric toothbrushes. And, if you can’t use all the free items for yourself, why not order items for your family and friend? After all, Pepto Bismol makes a great Christmas stocking stuffer!
5) Free Gym Memberships: What could make you look more impressive to your friends than having fobs from five different gyms dangling from your keychain? Especially when you tell them that your membership to all five gyms is FREE. Almost all Medicare Advantage plans give you free Silver Sneakers, or the equivalent, that lets you join as many gyms as you want to, paid for entirely by your plan. Most local gyms are included. You can even join out-of-town gyms for free if you travel.
Note: In life there is always a catch. Having a bunch of gym fobs, or even one, doesn’t make you fit without actually using the gym. But having the fobs is still a good start.
5) Other Perks: Medicare Advantage plans compete with each other by often offering perks that are unique to that plan. Some examples of these perks include routine chiropractic visits, routine podiatry visits, sometimes even acupuncture. All of these are medical services that are not covered by Original Medicare.
Does Medicare Advantage Cover Everything Original Medicare Does?
All the extras Medicare Advantage has are great but I am often asked by clients, “Does Medicare Advantage cover all the things I might need medically?”
Their concern tends to be, “It’s free. I’m getting a bunch of extra benefits for nothing. I must be missing something such as maybe Medicare Advantage doesn’t cover operations. What’s the catch?”
But not to worry. If you dislocate your right elbow while trying to push your dislocated left shoulder back into the socket then dislocations are covered by your Medicare Advantage plan with the possible warning that 65-year-olds should not be playing rugby.
The fact is that every Medicare Advantage plan must follow the minimum coverage requirements set by Medicare itself. This means that Medicare Advantage must cover everything Original Medicare covers, so rest assured that a Medicare Advantage plan cannot say we choose not to cover a particular test or procedure because it is too expensive. If Medicare itself covers a test or procedure then your Medicare Advantage plan must cover it, too.
The bottom line is that there are add-ons with Medicare Advantage plan coverage such as the dental, vision, and hearing we talked about in this section as well as prescription drug coverage almost always being included. There are ADD ONS with Medicare Advantage but NO SUBTRACTIONS.
In larger urban locations there are often 25 Medicare Advantage plan choices or being offered by up to 10 different carriers, some major and some smaller. The same major carrier such as AARP United Healthcare, Aetna or Humana may each have 6 or 7 plans to select from, including HMOs and PPOs.
So, with so many carriers and plans to choose from it’s a bit like being at an automobile dealer and trying to choose make, model and features from dozens of choices. Although, fortunately with Medicare Advantage you won’t also have to pick out a color as well
This is where weas as healthcare agents can be of great assistance. We will begin the process with you by learning about the four items below that are important in helping to pick the right plan for you:
1. The list of any doctors you want to have in your plan’s network. If you do not have a Primary care doctor, and your plan choice requires one as all HMOs do, then we will help you choose one.
Important to Know: When a carrier has several plans as most do, each plan will have a different doctor network. So it isn’t simply enough to think your doctor is in-network with AARP United, for example, because that may not be the case with all the AARP United Medicare Advantage plans. That is where our agent expertise in checking doctors against specific plans is so important.
2. Sometimes the prescription drugs you take are important to build into your quote as each Medicare Advantage plan formulates drugs differently. Your drugs could have much larger copays in one plan than in another. In some plans a drug you take may not be in formulary at all requiring you to pay for the drug100% out of pocket.
3. Extra benefits. Each plan will have “extras” that vary from plan to plan. One plan’s “extras” may appeal to you more than the extras of another. For instance, some plans offer more for dental benefits than other plans do.
4. And, of course, MONEY. It not only makes the world go round (according to the song) but it is another important reason why you might pick one plan over another. Given your current situation, or even what could happen, which plan is likely to cost you the least in copays?
We usually QUOTE THREE PLANS. In the quote you will see a side-by-side comparison breaking down what you will get with each plan known as a “Benefit” and what each plan will cost you in copayments or coinsurance. At the end of the quote you’ll also be able to download two documents that show you further information about a plan: The Summary of Benefits and the Evidence of Coverage.