America’s public wellness program was forever changed with the introduction of Medicare. It entitles all US citizens over 65 to qualify for specific government-funded healthcare benefits. The only requirement is that you need at least ten years of full-time employment.
Medicare Advantage was created in 1995 by the Federal government. This addition broadened the scope of services provided by Medicare. Although it has to be purchased through private health insurance firms, it’s still regulated by the authorities.
Is Medicare Advantage worth the extra cost? To answer this question, we need to take a comprehensive look at what this scheme offers.
Medicare Advantage Explained
Original Medicare’s benefits include part A and B coverage. Medicare Advantage, on the other, covers all four parts of the Medicare wellness program. Typically, this will include dental and vision care and prescription drugs. Learn more about Medicare Advantage plans on this link, which provides a detailed explanation of what this health insurance offers.
To qualify for this plan, you need to apply during the annual open enrollment period. It’s essential to keep in mind that opting for this insurance will result in added costs. You’ll have to pay the monthly premium for Original Medicare as well as a surcharge for the Medicare Advantage plan.
The plans have to be approved by Medicare, follow its guidelines, and be one of the following types of coverage:
- Health maintenance organization
- Preferred provider organization
- Private fee-for-service policy
Medicare Advantage – Advantages & Disadvantages
- Many added benefits, including prescription drugs, routine vision, and dental care, and hearing aids.
- Cost efficiency – Original Medicare comes with a coinsurance of 20%, whereas Medicare Advantage has a set copayment per doctor’s visit. Furthermore, your annual out-of-pocket expenses are capped. If you reach this limit, covered medical services will be paid in full for the rest of the year.
- Your healthcare and prescription drugs are taken care of in one location, making it convenient to work with one policy administrator.
- Medicare Advantage plans are coordinated wellness programs that have networks of contracted healthcare providers. You’re required to choose a primary physician to help manage this. Plans that cover prescription drugs will also cover medication therapy management.
- Specific procedures and services are only accessible with a doctor’s referral and need scheme authorization. This usually includes specific complicated procedures, visiting specialists, hospital stays, medical equipment, and home health care.
- You’re restricted to using medical practitioners and services within the scheme’s provider network. Unfortunately, limiting your freedom of choice. Using medical services not included in this system may result in you being responsible for paying the total amount incurred.
- Service area restrictions – Medicare Advantage schemes typically use regional networks of medical service providers. To qualify for your scheme’s benefits, you must spend at least six months of the year in your plan’s service area.
Original Medicare Vs. Medicare Advantage – What’s the Difference?
What Does it Cover?
Original Medicare plans cover most medical and hospital costs. Medicare Advantage comes with added benefits. On top of paying for this, it also covers dental, vision, and hearing care, and prescription drugs.
Are You Covered While Travelling?
Medicare will only cover your medical expenses as long as you’re in the United States. With Medicare Advantage, you’re covered wherever you are. It also comes with a lifetime emergency medical care cover of $50,000.
How Does Out-Of-Pocket Costs Work?
With Original Medicare, there are no set annual limits on out-of-pocket expenses. Medicare Advantage has a fixed annual cap on these costs. If you reach this limit, the scheme will pay in full for the rest of that year.
Coinsurance Vs. Copay
With Original Medicare, you’re responsible for paying an average coinsurance of 20%. This applies to the total cost of the health service that you used.
Medicare Advantage has a fixed copay amount with a set annual limit. This makes you responsible for a predetermined amount regardless of the cost of the health service.
Service Provider Network
With original Medicare, you have the luxury of using any doctor or clinic that accepts it. Medicare Advantage, unfortunately, limits your freedom of choice by binding you to a set network of medical service providers.
Is Medicare Advantage Worth the Extra Cost?
Medicare Advantage provides many services that aren’t accessible through original Medicare. It’s essential to evaluate the benefits of both schemes, and then decide if you need the extras.
Medicare Advantage schemes offer more extensive health care at a minimal additional extra expense to you. The only visible drawbacks are that you’re limited to the scheme’s network of service providers and bound to its rules.