The coverage of Medicare Advantage plans must be fully evaluated, to know all its benefits, scope and restrictions. The specialist mentioned that, joining a Medicare Advantage plan is completely voluntary. However, he highlighted that eight out of ten beneficiaries decide to take advantage of the benefits of a Medicare Advantage plan, while explaining its advantages and limitations.
General aspects: At a general level, a Medicare Advantage plan must guarantee all the services that the subscriber may need, aligned with all the benefits and services covered by original Medicare. In Advantage plans, this coverage will include Medicare provisions on Prescription Drug Plans (Medicare Part D).
Pharmacy: “It will cover the drugs prescribed by your doctors, including a minimum of two drugs per category and therapeutic class,” clarified the specialist, and emphasized that non-prescription drugs (OTC) are not included in this line.
Special coverage: “Medigap policies are the most common in Medicare, “They are available only to beneficiaries who have original Medicare, and not to those who join a Medicare Advantage plan,” these policies make up a supplemental plan that helps pay the 20% liability that applies to each beneficiary of original Medicare.
It is important to remember that these Medigap policies only cover costs related to 20% of benefits and other services covered by Medicare, such as the deductible for hospitalization. In other words, it does not add supplemental benefits that are not covered by Medicare.
Medigap policies are sold by private companies and that beneficiaries must meet certain eligibility criteria. An important consideration is that the company offering this policy can approve or reject your application, based on factors such as pre-existing conditions.
In that case, all treatment for chronic or catastrophic conditions must be covered, while it is approved by Medicare.
Every beneficiary should know in advance the additional factors that are based on their specific needs. Without proper guidance, they could cause you some future difficulties.
Network of doctors and drugs: The beneficiary will confirm that his network of doctors (including specialists) is within the network of the Medicare Advantage Plan he wants to choose. Also, it will confirm that your medications are included in the formulary of the plan you are considering subscribing to.
Service areas and coverage: If the Medicare beneficiary constantly travels between States, he should know that Medicare Advantage plans only cover emergency services. “Other medical-hospital services will not necessarily be covered, so the beneficiary will bear those expenses.
How much does Medicare cost: Most plans have low premiums and high coinsurance and deductibles or high premiums that are covered out of pocket. They could also have higher premiums with lower out-of-pocket costs. These costs, including premiums, change every year. For this reason, it is always important to look for a plan that fits both the budget and the medical needs.
Part A: No fee for the majority of beneficiaries
Part B: Appx 200$ per month will be automatically deducted from Social Security benefit payments. Individuals with an income of more than 100,000$ per annum, pay a higher premium.
Medicare Advantage: Appx 200$ monthly for the Part B premium, plus any additional premium set by the insurer.
Prescription drug plan: Premium varies by Medicare Plan, averages 35$ monthly.
Medigap: Amount varies by plan and scope of coverage.
Note: “Beneficiaries who did not pay enough Medicare taxes during the years must pay a $500 monthly premium.”
More Benefits Of Advantage Plans
- Complementary services to address social determinants of health (nutrition, exercise, mental health, emotion management).
- Support services for medical care (transportation to medical appointments and supermarkets, access to cash for food purchases, coverage of non-prescription or OTC drugs).
- Services for dental treatment (implants, crowns, fixed or removable bridges, among others).
- Vision and hearing improvement services (eye exams, help buying glasses or hearing aids).