To speak with a licensed insurance agent, call (248) 450-9980 (TTY 711 M-F, 9am-5pm) or email [email protected]
When you become eligible for Medicare, you face a series of choices. One of the first choices involves the type of plan you prefer.
Medicare Parts A and B comprise what is known as Original Medicare. But if you would prefer to enroll in a plan managed by a private health insurance company, you can choose Medicare Part C, or Medicare Advantage.
Medicare Advantage plans combine Part A and Part B benefits, and often include Part D (prescription drug) as well. Some beneficiaries prefer to have all of their coverage managed under one comprehensive plan.
You must be enrolled in both Medicare Part A and Part B in order to elect an Advantage plan, and you will continue to pay your Part B premiums. Medicare will then pay the Medicare Advantage plan administrator a set monthly amount to manage your care, and your Medicare Advantage plan will deliver your health care. You also must live within the Medicare Advantage plan’s service area.
The Difference Between Original Medicare and Medicare Advantage
Much of the difference between the two plans involves the way in which you access your care.
With Original Medicare, you are subject to deductibles and a 20 percent co-insurance on Part B. You can access care at any doctor’s office or hospital that accepts Medicare (which most do).
Under a Medicare Advantage plan, you access care through a network of providers in your coverage area. You will owe co-pays that vary for different services, depending upon how your plan is structured. Some plans will charge a per-day co-pay for hospital stays, while others charge a flat amount for the entire stay.
Medicare Advantage plans tend to change each year. However, beneficiaries have the opportunity to review their plans each year, and choose one that best suits their anticipated needs for the upcoming coverage year.
The Benefit of Having a Medicare Advantage Plan
Before Medicare Advantage was created, those with Original Medicare who could not afford a Medigap plan sometimes found themselves swamped in medical expenses when a serious illness or other incident occurred.
Medicare Advantage plans were created to provide a sort of safety net for catastrophic expenses. The plans include an out-of-pocket spending cap. The plans include an out-of-pocket spending cap. When beneficiaries reach that limit, the plan kicks in to cover medical expenses for the rest of the year (although Plan D expenses are calculated and managed separately).
Many Advantage plans also include Part D coverage for prescription drugs, so that beneficiaries don’t have to purchase a separate plan.
How to Choose a Medicare Advantage Plan
With so many options out there, choosing a Medicare plan can feel overwhelming to just about everyone. What works for one person might be completely wrong for another, so this is a very personal decision. Fortunately, insurance professionals dedicate themselves to learning all of the ins and outs of the different options available, and can guide you toward the plan(s) best suited for your needs.
First, ask yourself some important questions to begin identifying your priorities:
Are you attached to any specific healthcare providers? Do they accept any Medicare Advantage plans or only Original Medicare?
What types of insurance is accepted at your preferred hospital?
Do you frequently travel out of your coverage area, or do you spend significant time at a second home?
How much risk can you tolerate? Do you have savings or another source of funding in the event of significant medical bills?
How much peace of mind do you want to achieve? Do you need to know that your healthcare spending will remain steady over time? Or are you okay with fluctuating expenses?
HMO vs PPO
You are eligible for Medicare Part D when you first become eligible for Medicare (at age 65). You can consult with one of our licensed professionals, who will be happy to explain your plan options, or you can enroll in a Part D plan directly through Medicare. Call 1-800-MEDICARE or visit Medicare’s website for enrollment information.
If you opt for a Medicare Part C (Advantage) plan, Part D coverage might already be rolled into that policy.
Since Part D coverage is offered through private insurance companies with plans that vary, you should carefully consider each plan’s formulary to ensure that your preferred drugs will be available through the plan.
PPOs can offer more flexibility and out-of-network benefits. However, premiums can run quite a bit higher so it pays to have a broker do some “shopping” for you in order to find the best cost for your circumstances.
Choosing a Medicare plan requires research, time, and expertise.
As you can see, numerous factors will combine to lead you to your decision. The above summaries are a cursory guide, and are only intended to outline your basic options.
Working with a licensed insurance professional to research all of the options available to you, as well as address concerns specific to your situation, is still the best way to locate a Medicare policy that suits your needs and budget.
To speak with a licensed agent, call (248) 450-9980
(TTY 711 M-F, 9am-5pm)
Michigan License #0142917
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Medicare has neither reviewed nor endorsed this information.
Not connected with or endorsed by the United States government or the federal Medicare program.
We do not offer every plan available in your area. Currently we represent ten organization which offer different plan products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.