If you’re a senior looking for affordable healthcare, you’ve probably heard of (and may already be using) Medicare. It’s federally-funded health insurance, designed to get you the care you need at a lower cost.
When you sign up for Medicare, you have two options: Original Medicare or Medicare Advantage. We’re focusing on Medicare Advantage because it has extra benefits that Original Medicare doesn’t—including coverage for vision, hearing, dental services, and prescription drug coverage.
What does Medicare Advantage cover?
Medicare Advantage usually covers all three Medicare Parts:
- Medicare Part A: Covering hospitalizations. You usually won’t pay a premium for this, however, it’s possible you won’t qualify for premium-free Part A. If so, you can buy it.
- Medicare Part B: Covers medical insurance (non-emergency). Every Medicare Advantage enrollee pays a monthly premium for Part B.
- Medicare Part D: Covers prescription drug coverage. You pay for Part D coverage, and you’ll have extra out-of-pocket costs throughout the year. Only some Medicare Advantage plans offer this coverage.
We’ve covered the basics of Medicare Advantage, but you have more choices to make when it comes to choosing a plan. It can get confusing, which is why we’ll walk you through what to consider before making your decision.
What to consider when choosing coverage
Here are five factors to consider when choosing a Medicare Advantage plan:
Five factors to consider
- Costs: How much are the premiums, deductibles, out-of-pocket costs, and yearly caps?
- Coverage: How well does the plan cover your needs?
- Prescription drugs: Medicare Part D covers prescription drugs, but plans vary with costs of certain medications and which ones are covered.
- Doctor and hospital choice: You’ll only be able to visit doctors and hospitals that are within the plan’s network.
- Quality of care: Each Medicare Advantage Plan receives a star rating, so you can see how high its quality of care is before you enroll. Compare your options based on this factor using an online tool.
While you’re considering these factors, we highly recommend documenting your needs. This will help you remember what you need while you’re picking a plan.
Types of Medicare Advantage Plans
There are different types of plans. Here are the most common types of Medicare Advantage Plans:
Health Maintenance Organization (HMO)
An HMO generally limits coverage to care from doctors, hospitals, and providers who are within their network. HMOs typically have lower monthly premiums, but more limitations when it comes to which doctors they cover. With an HMO, prescription costs aren’t usually covered.
Preferred Provider Organization (PPO)
Similarly to an HMO, PPO plans have a network of doctors and healthcare providers that are cheaper to use. You can use other providers, but they’re more expensive. You’ll have more flexibility than your typical HMO plan, and unlike HMOs, prescription drugs are usually covered.
Private Fee-for-Service (PFFS)
Some PFFS plans work with any provider, while others have a network of specific doctors. Often, you can go outside of that network for a higher cost. This plan determines how much it will pay, versus how much you must pay when you get care. Prescription drugs aren’t always covered under an PFFS.
Special Needs Plans (SNPs)
According to Medicare, “SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.” The chronic or disabling conditions these plans tailor to include: diabetes, HIV/AIDS, and dementia.
Care will typically be provided by specialists that cover your condition.
Joining a Medicare Advantage Plan
Once you decide what plan is best for you, all that’s left to do is enroll. You can enroll when you turn 65 or during open enrollment (every year from October 15 – December 7). You’ll also be able to switch plans one time from January 1 – March 31 each year.
When you’re ready to sign up, Medicare has created a resource to help you through the process.
Ōmcare engages with Medicare plans
Ōmcare’s goals are to help increase access to senior patients while reducing costs. Yet at the same time, we seek to improve health outcomes. We actively engage with Medicare plans to help bring cost-effective healthcare technology into your home as part of the price you already pay.