Medicare Advantage Plans

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Comparing Some Popular 2016 Medicare Advantage Plans

Anyone who is aging into medicare benefits pool has a lot to consider when determining what will be the best option for their needs. There is no one size fits all solution, and most often we find that people have the best outcome simply by speaking with a licensed medicare insurance specialist. Let’s not sugar-coat things, medicare, despite how much effort anyone takes, including us here at Medicare.net, it is confusing. When you add the natural level of anxiety that one will have during this research process, it is quite easy to understand why people often find themselves in “analysis paralysis” mode and unable to select a plan until the very last minute.

We will always advise anyone who has questions or concerns to absolutely connect with a licensed medicare professional. There is never any cost associated with getting answers from a licensed agent, and CMS and the US Government strictly control the licensing and continuing education process for anyone involved with the sale or enrollment of a medicare product.

Medicare Advantage Plans For 2016 Click Here To Get 2016 Pricing

That said, we often get emails from individuals asking us to do plan comparisons, reviews and analysis, so that’s precisely what we are doing below. You’ll find detailed information on a variety of popular plans, in a number of different cities, and this in fact can be one of the very best ways that you can start to familiarize yourself with the medicare advantage options that are being offered by insurance carriers for the 2016 year.

Medicare.net Analysis of Popular Medicare Advantage Plans Within The US For 2016

BlueCross BlueShield (55988 – Stockton, MN)

BlueCross BlueShield operates more than 30 distinct health insurance carriers in the United States and covers over 100 million people. Depending on where you live, you may see BlueCross BlueShield listed as two separate entities, BCBS of Your Region or another name. Seniors living in Minnesota have six options for Medicare Advantage plans from BlueCross BlueShield. They include:

  • Platinum Blue Core Plan
  • Platinum Blue Core Plan with Rx
  • Platinum Blue Choice Plan
  • Platinum Blue Choice Plan with Rx
  • Platinum Blue Complete Plan
  • Platinum Blue Complete Plan with Rx

BlueCross BlueShield does not offer any premium-free Advantage plans in Minnesota so each of these plans has a monthly cost. However, none of the plans have annual deductibles, and each of the non-Rx plans is rated 4.5 stars with the Centers for Medicare & Medicaid Services (CMS).

Here’s an outline of the costs associated with each non-Rx plan from BCBS in Minnesota:

Core Choice Complete
Premium $29 plus Part B $74 plus Part B $109 plus Part B
Deductible (health) None None None
Copays/coinsurance
  • 20% primary and specialist
  • $50 urgent care
  • $50 ER visit
  • $500 hospital
  • $15 primary and specialist
  • $25 urgent care
  • $50 ER visit
  • $100 hospital

No copays or coinsurance for primary, specialist, urgent care, ER or hospital stays

Out-of-pocket max $5,000 $3,000 $3,000
Prescriptions Not covered Not covered Not covered
Hospital stays $500/day up to 90 days No copay until ≥ 91 days Unlimited hospital stay coverage
Skilled nursing care
  • No copay up to 20 days
  • $150/day for days 21-100
  • Covers 100 days
  • no copay
  • Covers 100 days
  • no copay
Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
Rating with CMS 4.5 4.5 4.5

With Core, the premium is $29 a month, and beneficiaries are responsible for 20 percent of the cost for both primary and specialist care. There’s a $25 copay for urgent care. For emergency room visits, there’s a $50 copay unless you’re admitted into the hospital within 24 hours. How much you pay for hospital stays depends on the benefit period, but there’s a base $500 copay per stay. For Choice beneficiaries, the premium is higher at $74 a month, but the copays are lower, as are the out-pocket maximums and hospital charges. For skilled nursing care, beneficiaries under the Choice plan don’t pay anything up to 100 days. Platinum Blue Complete doesn’t charge copays or coinsurance, and it has a lower out-of-pocket maximum than Core. Hospital stays are completely covered. Complete has a much higher premium, however, at $109 a month.

Medicare Advantage Plans For 2016 Click Here To Get 2016 Pricing

For Medicare beneficiaries who need prescription coverage, BCBS offers the Core, Choice and Complete plans with an Rx option. The health plan portion of these Advantage plans are the same as the non-Rx plans, which means all of the outpatient, hospital and other costs remain the same. The difference is that Rx plans cover prescriptions for an added monthly premium cost of $9.90 for Core, $29.40 for Choice and $55.50 for Complete.

Here’s a breakdown of what you might pay with the Rx plans from BlueCross BlueShield:

Core Choice Complete
Premium $38.90 plus Part B $103.40 plus Part B $164.50 plus Part B
Drug copays/coinsurance $0-40/ 25-50% $2-40/ 25-50% $0-35/ 25-50%
Deductible $360 $360 $360
Covered Rx 20% of most covered drugs under Part B 20% of most covered drugs under Part B 0 – 20% of most covered drugs under Part B
Coverage gap $3,310 $3,310 $3,310
Catastrophic coverage $4,850 $4,850 $4,850

The coverage gap for these Rx plans starts at $3,310, which means that once you hit that limit for the year in covered prescription costs, you’re in the donut hole until you reach the spending maximum at $4,850. During the gap, you’ll pay 45 percent of what the plan covers for brand name drugs and 58 percent of what the plan pays for generics. Individual drug costs depend on tiers and how the plan categorizes your medication.

Coventry/Advantra Medicare Advantage -Pittsburgh, PA

HealthAmerica, which is a Coventry Health Care/Aetna company, offers seven Medicare Advantage plans under its Advantra label in Pennsylvania. Four are HMO plans; the other three are PPOs. The primary difference between HMOs (health maintenance organizations) and PPOs (preferred provider organizations) is that HMOs don’t cover any out-of-network treatments and services, except in urgent or emergency cases. Medicare enrollees can choose from the following Coventry Advantage options:

  • AdvantraOne (PPO)
  • Advantra Silver (PPO)
  • Advantra Gold (PPO)
  • Advantra Choice Plan (HMO)
  • Advantra Basic Medical (HMO)
  • Advantra Silver (HMO)
  • Advantra Gold (HMO)

There are benefits and drawbacks to HMO and PPO plans. HMOs typically have lower premiums but heavier restrictions on providers. PPOs give you more provider options, but premiums are higher and there’s usually a deductible.

Coventry offers the following PPO options for Advantage plans:

AdvantraOne Silver PPO Gold PPO
Premium $23 plus Part B $81 plus Part B $138 plus Part B
Copays/ coinsurance for in-network providers
  • $35 primary
  • $50 specialist
  • $50 urgent care
  • $75 ER visit
  • $5 primary
  • $45 specialist
  • $50 urgent care
  • $75 ER visit
  • $5 primary
  • $45 specialist
  • $50 urgent care
  • $75 ER visit
Deductible (health) $1,600 for out-of-network providers $1,000 for out-of-network providers $750 for some in- and out-of-network providers
Out-of-pocket max
  • $6,700 (in-network)
  • $10,000 (all)
  • $6,700 (in-network)
  • $10,000 (all)
  • $6,700 (in-network)
  • $10,000 (all)
Prescriptions
  • No deductible $8-100
  • copay 33% coinsurance
  • No deductible $9-100
  • copay 33% coinsurance
  • No deductible $5-47
  • copay 33-50% coinsurance
Hospital stays
  • $540 copay (1-3 days)
  • No cost for day 4+
  • $150 copay (1-5 days)
  • No cost for day 6+
    • $450 copay until 90 days
    • No cost for day 91+
    Skilled nursing care
    • No copay up to 20 days
    • $160/day for days 21-100
    • No copay up to 20 days $95/day for days 21-25
    • $160/day for days 26-100
    • No copay up to 20 days $95/day for days 21-25
    • $160/day for days 26-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 3.5 3.5 3.5
    Rx rating 4.5 4.5 4.5

    All three PPO plans include prescription coverage, but the amount varies based on drug tier and plan type. AdvantraOne, for instance, covers 20 percent of the cost of in-network Part B prescriptions, including chemotherapy drugs. The other two plans also cover this percentage, and all three plans cover 40 percent of out-of-network Part B drugs. How much you pay for prescriptions depends on the plan as well. With Silver, beneficiaries pay a $9 copay for a 1-month supply of tier 1 drugs while Gold beneficiaries would pay $5 for the same 1-month supply of a tier 1 drug. There are four or five tiers depending on plan type, so if you need monthly medications, check with the plan for full details on cost.

    Coventry also offers four HMO plans:

    Choice Basic Medical Silver HMO Gold HMO
    Premium $0 plus Part B $19 plus Part B $29 plus Part B $112 plus Part B
    Copays/ coinsurance for in-network providers
    • $10 primary
    • $45 specialist
    • $55 urgent care
    • $75 ER visit
    • $10 primary
    • $50 specialist
    • $50 urgent care
    • $75 ER visit
    • $15 primary
    • $40 specialist
    • $50 urgent care
    • $75 ER visit
    • $5 primary
    • $40 specialist
    • $50 urgent care
    • $75 ER visit
    Deductible (health) $985 None None Varies
    Out-of-pocket max $6,700 $6,700 $6,700 $6,700
    Prescriptions
    • No deductible
      $7-47
    • copay 33-50% coinsurance
    N/A
    • $140 deductible
      $7-47
    • copay 33-50% coinsurance
    • No deductible
      $7-100
    • copay 33% coinsurance
    Hospital stays $555 copay ≤ 90 days $225 copay (1-7 days) $195 copay (1-9 days) $400 copay ≤ 90 days
    Skilled nursing care
    • No copay up to 20 days
    • $160/day for days 21-100
    • No copay up to 20 days
    • $160/day for days 21-100
    • No copay up to 20 days
    • $95/day for days 21-25
    • $160/day for days 26-100
    • No copay up to 20 days
    • $95/day for days 21-25
    • $160/day for days 26-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost Home health care
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost Hospice
    Health plan rating 4 4 4 4
    Rx rating 4 N/A 4 4

    When comparing Coventry’s PPO and HMO plans, you’ll notice that the costs are about the same in terms of copays and monthly premiums for Gold-level plans. The difference lies in factors like which providers you can see and how much a plan pays for in-network vs. out-of-network costs. HMO plans have a tier of “preferred generic” prescriptions while PPOs don’t, but PPOs will cover some of the cost of out-of-network providers while HMOs won’t. Both types of plans offer extra coverage, like vision, but exclude services such as transportation and acupuncture. Choosing the Advantage plan that fits your needs will depend on your prescriptions and overall health.

    Medicare Advantage Plans For 2016 Click Here To Get 2016 Pricing

    Humana Medicare Advantage – Chattanooga, TN

    Humana is one of the top insurance carriers in the country, covering about 13 million people throughout the U.S. as of 2014. The company offers several Medicare Advantage plans. In Tennessee, Medicare enrollees have seven plan options for Medicare Advantage, three of which are PPOs and four of which are HMOs. They are:

    • HumanaChoice Regional PPO (R5926-001)
    • HumanaChoice Regional PPO (R5926-065)
    • HumanaChoice PPO (H6609-090)
    • Humana Gold Plus SNP-DE, HMO
    • Humana Gold Plus HMO (H4461-004)
    • Humana Gold Plus HMO (H4461-030)
    • Humana Gold Plus HMO (H4461-031)

    Humana’s PPO options include relatively low deductibles and low to moderate monthly premiums. You can visit any doctor, but you’ll pay more out of pocket for out-of-network providers. The Regional PPO (065) plan has no premium, a low deductible and a low out-of-pocket maximum for in-network providers. However, in-network hospital stays cost twice as much per day with this plan as they do with the other two PPOs. The Regional PPO (001) plan has the highest monthly premium at $75 and the highest deductible at $1,000. You’ll also pay more for prescriptions, but this plan has a higher drug plan rating than the HumanaChoice PPO.

    HumanaChoice Medicare Advantage Plans – HumanaChoice PPO Plans

    HumanaChoice Regional PPO (001) HumanaChoice Regional PPO (065) HumanaChoice PPO (H6609-090)
    Premium $75 plus Part B $0 plus Part B $57 plus Part B
    Copays/ coinsurance for in-network providers
    • $20 primary
    • $20-45 specialist
    • $20-45 or 40% urgent care $75 ER visit
    • $10 primary
    • $10-30 specialist
    • $10-30 or 30% urgent $75 ER visit
    • $20 primary
    • $20-40 specialist
    • $20-40 or 30% urgent $75 ER visit
    Deductible (health) $1,000 for out-of-network providers $500 for out-of-network providers $900 for some in- and out-of-network providers
    Out-of-pocket max
    • $6,700 (in-network)
    • $10,000 (all)
    • $3,400 (in-network)
    • $5,100 (all)
    • $6,700 (in-network)
    • $10,000 (all)
    Prescriptions
  • $360 deductible on Part D except tiers 1, 2 and 3 $4-95
  • copay 25% coinsurance
  • N/A
    • $275 deductible on Part D except tiers 1, 2 and 3 $7-97
    • copay 26% coinsurance
    Hospital stays (in-network)
    • $275/day for days 1-6
    • No cost for day 7+
    • $550/day for days 1-6
    • No cost for day 7+
    • $275/day for days 1-6
    • No cost for day 7+
    Skilled nursing care (in-network)
    • No out-of-pocket cost up to 20 days
    • $150/day for days 21-100
    • No out-of-pocket cost up to 7 days
    • $40/day for days 8-20
    • $100/day for days 21-100
    • No out-of-pocket cost up to 20 days
    • $150/day for days 21-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 3.5 3.5 4
    Rx rating 4.5 N/A 4

    HumanaChoice PPO, the non-regional option, offers a moderate premium of $57 and a higher deductible of $900. The coinsurance rate for prescriptions is higher than the other plans, but it has a 4-star rating for both its health plan and drug plan. If you’re interested in an HMO plan, then Humana offers the following choices:

    Gold Plus SNP-DE, HMO Gold Plus HMO (H4461-004) Gold Plus HMO (H4461-030) Gold Plus HMO (H4461-031)
    Premium $112 $45 plus Part B $118 plus Part B $48 plus Part B
    Copays/ coinsurance for in-network providers No copays for primary, specialist or urgent care
    • $10 primary
    • $10-30 specialist
    • $10-30 urgent
    • $75 ER visit
    • $10 primary
    • $10-40 specialist
    • $10-40urgent
    • $75 ER visit
    • $15 primary
    • $15-40 specialist
    • $15-40 urgent
    • $75 ER visit
    Deductible (health) None None Rx only Rx only
    Out-of-pocket max $6,700 $5,900 $5,900 $6,700
    Prescriptions No cost for Part B drugs $2.95-7.40 for other drugs Not covered
    • $200 deductible on Part D except tiers 1, 2 and 3 $5-97
    • copay 28% coinsurance
    • $225 deductible on Part D except tiers 1, 2 and 3 $5-97
    • copay 28% coinsurance
    Hospital stays $630/day for days 91-150 No copay for first 90 days or days 151+ (unlimited number of days) No copays
    • No copay for first 90 days
    • $150 copay/day for days 91+
    • $285 copay (1-6 days)
    • No cost for day 7+
    Skilled nursing care
    • Covers 100 days
    • no copays
    • No copay up to 20 days
    • $160/day for days 21-100
    • No copay up to 20 days
    • $95/day for days 21-25 days
    • $160/day for days 26-100
    • No copay up to 20 days
    • $95/day for days 21-25
    • $160 for days 26-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 4.5 4.5 4.5 4.5
    Rx rating 5 N/A 5 5

    Humana’s Gold Plus SNP-DE HMO plan doesn’t charge copays for regular, specialist or urgent care visits, and Part B drugs that you get at your doctor’s office are covered at no cost to you. The premium, however, is high at $112 a month, and the out-of-pocket maximum is $6,700. Hospital stays also cost more with this plan, but there’s no out-of-pocket cost for skilled nursing care, which is covered for 100 days. Gold Plus (004) offers the lowest premium at $45, but this plan does not come with prescription coverage.

    If you don’t need prescriptions, though, the (004) plan may be a good choice because hospital stays are fully covered, as are home health care and hospice services. The Gold Plus (030) plan has a relatively high monthly premium, a $200 deductible on certain Part D drugs and no charge for hospital stays up to 90 days. Gold Plus (031) has a comparable premium to the (004) plan, but this plan comes with prescription coverage and shares similar features with the (030) plan. All of the HMO plans that come with prescription coverage have a 5-star rating, and all of the HMO medical plans have 4.5-star ratings.

    Aetna Medicare Advantage Plans – Ft. Lauderdale, FL

    Headquartered in Hartford, CT, Aetna has been offering insurance products in the United States for over 160 years. The company acquired Coventry Health Care, Inc. in 2013, adding to its existing pool of Medicare Advantage offerings for senior citizens throughout the country. In Florida, Medicare Advantage enrollees can choose from four HMO plans and two PPO plans:

    • Coventry Vista Ideal HMO
    • Coventry Summit Ideal HMO
    • Coventry Summit Maximum HMO
    • Aetna Medicare Connect Plus HMO
    • Aetna Medicare Premier Plan PPO
    • Aetna Medicare Connect Plus PPO

    Coventry Summit Maximum HMO doesn’t charge copays for primary care visits, specialist visits or emergency care. It also has extra benefits that may be useful to you, such as mental health care, chiropractic services and ambulance transportation at no additional out-of-pocket cost. The plan also covers prescription eyeglasses or contacts up to $300 each year, and prescriptions cost less with this option. When you’re comparing plans, look for the features that matter most to you. If you don’t need prescription glasses, for example, then choosing a plan with great vision coverage isn’t as important. Here are some of the basic features of each HMO plan with Aetna/Coventry:

    Coventry Vista Ideal HMO Coventry Summit Maximum HMO Coventry Summit Ideal HMO Aetna Medicare Connect + HMO
    Premium $0 plus Part B $0 plus Part B $0 plus Part B $112 plus Part B
    Copays/ coinsurance for in-network providers
    • No copays for primary $10 specialist
    • $50 urgent care
    • $75 ER visits
    No copays for primary, specialist, urgent care or ER visits
    • No copays for primary $10-40 specialist
    • $10-40 urgent
    • $75 ER visit
    • No copays for primary $15 specialist
    • $50 urgent care
    • $75 ER visits
    Deductible (health) None None None None
    Out-of-pocket max $5,000 $3,400 $3,400 $4,500
    Prescriptions
    • No deductible $0-30 copay
    • 33-50% coinsurance
    • No deductible $2.95-7.40 copay
    • No coinsurance
    • No deductible $0-15 copay
    • 33-50% coinsurance
    • No deductible $0-47 copay
    • 33-50% coinsurance
    Hospital stays
    • $195/day for days 1-5
    • No cost for day 6+
    No copays
    • $95/day for days 1-7
    • No cost for day 8+
    • $200/day for days 1-4
    • No cost for day 5+
    Skilled nursing care
    • No copay for days 1-20
    • $150/day for days 21-100
    • Covers 100 days
    • no copays
    • No copay for days 1-20
    • $75/day for days 21-100
    • No copay for days 1-10
    • $25/day for days 11-20
    • $150/day for days 21-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 3.5 3.5 3.5 3.5
    Rx rating 3.5 3.5 3.5 3.5

    Coventry Vista and Summit Ideal are similar in terms of copays and coinsurance, but Summit Ideal has a lower out-of-pocket maximum and lower copay for prescriptions. Vista Ideal charges more for hospital stays and skilled nursing care than Summit Ideal. Aetna Medicare Connect Plus charges a premium of $112 a month, but there are no copays for primary care. On the Connect Plus plan, you’ll only pay for hospital stays for the first four days. None of the Coventry plans charge monthly premiums aside from the regular Part B premium, and none of the HMO plans charge a deductible. All of the plans have the same 3.5-star rating for both medical and prescription coverage. If you’re looking for more provider options, then a PPO plan could be a better choice. Here’s a breakdown of Aetna’s PPO plans:

    Aetna Medicare Premier Plan PPO Aetna Medicare Connect Plus PPO
    Premium $49 plus Part B $188 plus Part B
    Copays/ coinsurance for in-network providers
    • No copays for primary $50 specialist
    • $0-50 urgent care
    • $75 ER visit
    • No copays for primary $15 specialist
    • $0-50 urgent care
    • $75 ER visit
    Deductible (health) None None for in-network
    Out-of-pocket max
    • $6,700 in-network
    • $10,000 any provider
    • $6,700 in-network
    • $7,500 out-of-network
    • $7,500 any provider
    Prescriptions
    • $150 deductible for Part D drugs except tiers 1 and 2 $3-45
    • copay 29-50% coinsurance
    • No Part D deductible $0-47 copay
    • 33-50% coinsurance
    Hospital stays
    • $295/day for days 1-6
    • No copay for day 7+
    • $200/day for days 1-6
    • No copay for day 7+
    Skilled nursing care
    • No out-of-pocket cost up to 20 days
    • $160 per day for days 21-100
    • No out-of-pocket cost up to 20 days
    • $75 per day for days 21-100
    Home health care No out-of-pocket cost (in-network) No out-of-pocket cost (in-network)
    Hospice No out-of-pocket cost No out-of-pocket cost
    Health plan rating 4.5 4.5
    Rx rating 5 5

    Connect Plus has a lower out-of-pocket maximum for services that you get outside of the network, but its premium is substantially higher at $188 a month. Premier Plan charges a $150 deductible for Part D drugs outside of the first two tiers, but its prescription coinsurance rate is lower, as is its monthly premium of $49.

    The copay and out-of-pocket maximum amounts listed here reflect in-network costs. If you go outside of the network with either plan, you’ll most likely pay more for services. For instance, Aetna Connect Plus PPO doesn’t charge a copay for in-network primary care, but you’ll pay 20 percent of the cost for out-of-network primary care. Premier Plan PPO charges a $75 copay for out-of-network primary care. Make sure that you research out-of-network charges when comparing PPO plans.

    UnitedHealthcare Medicare Advantage Plans – Bridgeport, CT

    As the largest single health carrier in the country, UnitedHealthcare serves more than 70 million customers nationwide. The company ranks 14th on the Fortune 500 list and offers several Medicare Advantage plans in most states. In Connecticut, for instance, Medicare Advantage enrollees can choose from seven plans – three PPOs and four HMOs – one of which is a regional PPO plan offered in conjunction with AARP:

    • Assisted Living Plan PPO
    • Nursing Home Plan PPO
    • AARP Medicare Choice Complete PPO
    • UHC Medicare Complete Plan 1 HMO
    • UHC Medicare Complete Plan 2 HMO
    • UHC Medicare Complete Plan 3 HMO
    • UHC Medicare Complete Essential HMO

    The UHC Medicare Advantage PPO plans cover services for both in-network and out-of-network providers, but there’s a higher cost for seeing out-of-network doctors. In some cases, the difference isn’t as great, as with the Nursing Home PPO, which charges up to 20 percent of the cost for in-network specialist care and 30 percent for out-of-network specialists. None of the PPO plans charge a copay for primary care or a yearly deductible for the medical plan. Complete Choice PPO seems to have the highest upfront costs, a high Part D deductible and the highest copay cost for hospital stays. However, its drug rating is the best-rated one among the PPO plans.

    Assisted Living Plan PPO Nursing Home Plan PPO AARP Medicare Complete Choice PPO
    Premium $21.20 plus Part B $31.10 plus Part B $50 plus Part B
    Copays/ coinsurance for in-network providers
    • No copay for primary
    • $25 specialist
    • $30-40 urgent care
    • $75 ER visits
    • No copay for primary
    • 0-20% specialist
    • 20% urgent
    • $75 ER visit
    • $20 primary
    • $45 specialist
    • 20% urgent
    • $75 ER visit
    Deductible (health) None None None
    Out-of-pocket max
    • $3,500 (in-network)
    • $10,000 (all)
    • $5,000 (in-network)
    • $10,000 (all)
    • $5,500 (in-network)
    • $10,000 (all)
    Prescriptions
    • $105 deductible Part D
    • except tiers 1, 2, and 3 $2-100
    • copay 30% coinsurance
    • $360 deductible Part D
    • copay N/A No coinsurance
    • copay 25% coinsurance
    • $310 deductible Part D
    • except tiers 1 and 2 $2-100
    • copay 26% coinsurance
    Hospital stays (in-network)
    • $250/day for days 1-7
    • No cost for day 8+
    Based on benefit period
    • $495/day for days 1-3
    • No cost for day 4+
    Skilled nursing care (in-network) Covers 100 days, no copays Covers 100 days, no copays
    • No copay for days 1-20
    • $160/day for days 21-55
    • No copay for days 56-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 4 4 4
    Rx rating 4 4 4.5

    Both the Assisted Living and Nursing Home plans cover skilled nursing care for 100 days without a copay, and all of the PPO plans cover home health care and hospice care for no out-of-pocket cost to beneficiaries.

    UnitedHealthcare’s HMO plans offer the following benefits:

    UHC Medicare Complete Plan 1 HMO UHC Medicare Complete Plan 2 HMO UHC Medicare Complete Plan 3 HMO UHC Medicare Complete Essential HMO
    Premium $99 plus Part B $29 plus Part B $0 plus Part B $0 plus Part B
    Copays/ coinsurance for in-network providers
    • $10 primary
    • $30 specialist
    • $30-40 urgent
    • $75 ER visits
    • $15 primary
    • $40 specialist
    • $30-40 urgent
    • $75 ER visits
    • $20 primary
    • $50 specialist
    • $30-40 urgent
    • $75 ER visits
    • $15 primary
    • $40 specialist
    • $30-40 urgent
    • $75 ER visits
    Deductible (health) None None None None
    Out-of-pocket max $3,400 $6,000 $6,700 $6,000
    Prescriptions
    • $130 deductible for Part D
    • except tiers 1 and 2 $2-95
    • copay 30% coinsurance
    • $200 deductible for Part D
    • except tiers 1 and 2 $2-95
    • copay 28% coinsurance
    • $140 deductible for Part D
    • except tiers 1 and 2 $2-95
    • copay 30% coinsurance
    Not covered
    Hospital stays
    • $345/day for days 1-5
    • No cost for day 6+
    • $395/day for days 1-4
    • No cost for day 5+
    • $430/day for days 1-4
    • No cost for day 5+
    • $395/day for days 1-4
    • No cost for day 5+
    Skilled nursing care
    • No copay for days 1-20
    • $160/day for days 21-42
    • No copay for days 43-100
    • No copay for days 1-20
    • $160/day for days 21-58
    • No copay for days 59-100
    • No copay for days 1-20
    • $160/day for days 21-62
    • No copay for days 63-100
    • No copay for days 1-20
    • $160/day for days 21-58
    • No copay for days 59-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 4 4 4 4
    Rx rating 4 4 4 N/A

    UHC Medicare Complete Essential HMO has no premium or annual deductible, and its costs are relatively low for primary, specialist and urgent care services. However, this plan does not cover prescriptions. The other three HMO plans do offer drug coverage, making them better choices if you need prescriptions. All four HMOs have 4-star ratings for their health plans, and the cost for hospital stays is comparable across the board, as is the cost of skilled nursing care. Complete Plan 1 has the lowest out-of-pocket maximum at $3,400 while Complete Plan 3 has the highest at $6,700. Both of these plans have lower Part D drug deductibles than Complete Plan 2, but all three plans charge about the same copay for prescriptions. All of the UHC HMO plans come with an optional package that includes dental, and Complete Plan 1 also has a fitness rider for an additional charge.

    AARP Medicare Advantage Plans – Newton Falls, OH

    AARP was founded in 1958 to serve the needs of American retirees, and the company continues to work toward this mission by helping seniors achieve their post-retirement goals. As part of its service to members, AARP offers Medicare Advantage plans through UnitedHealthcare, but the plans are limited in number compared with plans offered by other carriers. In Ohio, members can choose from four HMO plans with AARP/UHC:

    • AARP Medicare Complete Plan 1 HMO
    • AARP Medicare Complete Plan 3 HMO
    • AARP Medicare Complete Plan 7 HMO
    • AARP Medicare Complete Essential HMO

    Remember that HMOs typically require lower out-of-pocket costs than PPOs, but you most likely won’t be covered if you go out of network for services. There are no PPO or POS (point of service) plans available from AARP in Ohio. Here’s an overview of the HMO plans in this state:

    AARP Medicare Complete Plan 1 HMO AARP Medicare Complete Plan 3 HMO AARP Medicare Complete Plan 7 HMO AARP Medicare Complete Essential HMO
    Premium $29 plus Part B $120 plus Part B $0 plus Part B $45 plus Part B
    Copays/ coinsurance for in-network providers
    • No copay for days 1-20
    • $160/day for days 21-42
    • No copay for days 43-100
    • No copay for days 1-20
    • $160/day for days 21-58
    • No copay for days 59-100
    • No copay for days 1-20
    • $160/day for days 21-62
    • No copay for days 63-100
    • No copay for days 1-20
    • $160/day for days 21-58
    • No copay for days 59-100
    Deductible (health) None None None None
    Out-of-pocket max $3,900 $2,900 $4,500 $5,900
    Prescriptions
    • $200 deductible for Part D
    • except tiers 1 and 2 $2-95
    • copay 28% coinsurance
    • $200 deductible for Part D
    • except tiers 1 and 2 $0-100
    • copay 33% coinsurance
    • $255 deductible for Part D
    • except tiers 1 and 2 $0-100
    • copay 27% coinsurance
    Not covered
    Hospital stays
    • $295/day for days 1-5
    • No cost for day 6+
    • $195/day for days 1-5
    • No cost for day 6+
    • $340/day for days 1-5
    • No cost for day 6+
    • $350/day for days 1-5
    • No cost for day 6+
    Skilled nursing care
    • No copay for days 1-20
    • $160/day for days 21-45
    • No copay for days 46-100
    • No copay for days 1-20
    • $160/day for days 21-39
    • No copay for days 40-100
    • No copay for days 1-20
    • $160/day for days 21-49
    • No copay for days 50-100
    • No copay for days 1-20
    • $160/day for days 21-57
    • No copay for days 58-100
    Home health care No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Hospice No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost No out-of-pocket cost
    Health plan rating 4.5 4.5 4.5 4.5
    Rx rating 4.5 4.5 4.5 N/A

    Complete Plan 7 doesn’t charge a monthly premium, but its out-of-pocket threshold is fairly high at $4,500 for the year. Complete Plan 1 has a low monthly premium and a lower out-of-pocket maximum. If you need routine monthly prescriptions, you may want to ignore Complete Essential since this plan doesn’t cover prescription drugs.

    All four HMO plans carry a 4.5-star health rating from the CMS, and none of them charge beneficiaries for home health or hospice care. They’re all about the same when it comes to the cost of skilled nursing care, but there are some differences with the hospital coverage. For instance, Complete Plan 3 charges $195 per day for the first five days while Complete Essential charges $350 for the same period. For the drug plans, all three plans have a similar deductible and coinsurance rate.

    This is the end of our example analysis for 2016 Medicare Advantage Plans. We hope this has been helpful and insightful, and please feel free to continue to contact us and request additional types of information.

    Copyright Medicare.net 2016

    Original Medicare vs. Medicare Advantage

    When people think about Medicare, they think about the healthcare of an older generation. Baby boomers started to reach retirement age two years ago. The boomers, as well as their older peers, are known as the “greatest generation.” This is the generation known   for sound decision-making and practicing pragmatism.  However, boomers aren’t the only ones who qualify for Medicare, or more on topic, a Medicare Advantage plan as an option.

    When it comes to healthcare, it can be difficult to understand all of the different plans that come with Medicare. But making the right decision is important when it comes to saving money and worrying less about your coverage. Many seniors and those who have recently become eligible for Medicare are also finding that they can get a private health insurance plan through Medicare Advantage and save money, as well. Medicare Advantage plans are offered through private health insurance companies and must be approved by Medicare. They are also rated from 1 to 5 stars, with 5 stars being an excellent plan.

    If you are thinking of switching to Medicare Advantage Plan, or if you will be eligible to enroll in Medicare soon, you should take a look at comparisons between Medicare and Medicare Advantage. By understanding what each type of healthcare can offer you, you may be able to get more benefits for a lower monthly premium. This guide goes through a few of the differences between Original Medicare and Medicare Advantage.

    Original Medicare vs. Medicare Advantage plans

    Commonly known as “straight” Medicare by the medical community, Original Medicare comprises two parts. Part A provides services for hospital, nursing and hospice care. Part B provides services for physician care, labs, tests and durable medical equipment. Part D covers medical prescriptions and is purchased through commercial insurance providers.

    Under Original Medicare, providers carry the bulk of service responsibilities. They bill and are generally paid within 14 days of providing service. Known as Fee for Service (FFS), this is a single-payer plan administered by the federal government.

    Once you turn 65 or after 24 months of receiving Social Security for a disability, you are automatically enrolled in Medicare. However, you have the option of choosing Medicare Part C or Medicare Advantage.

    What is Medicare Advantage?

    Medicare Advantage (Medicare Part C) was introduced with the specific purpose of driving down costs, as it provided more options for consumers. These plans are managed and administered by private insurance companies. But they still operate under Medicare and must be approved before being made available to the public.

    Medicare Advantage Plans must include the same benefits as Original Medicare. Any basic services available under Part A and Part B must also be included in a Medicare Advantage Plan offered by a private company.

    You can purchase Medicare Advantage plans during open enrollment periods (OEPs) or special enrollment periods (SEPs). You can enroll, switch or change your plan only during these times of the year. You can find and compare Medicare Advantage Plans on HealthNetwork.com or you can use Medicare.gov. It’s important when looking at Medicare Advantage plans that you read through the benefits and understand the costs.

    Confusion is one of the biggest challenges facing Medicare providers, as they attempt to educate people regarding Medicare Advantage. Misinformation and poor understanding often increase stress and consumer costs and may delay treatment. There are three vital principles that must be understood to help eliminate unwelcomed surprises, as you receive care appropriate to your need.

    Myths about Original Medicare and Medicare Advantage

    There are a few misconceptions floating around about Medicare and Medicare Advantage since changes were made under the Affordable Care Act (ACA). Some of these myths include the following:

    • People can enroll in Medicare or Medicare Part C at any time.
      • False, but most people are automatically enrolled in Medicare Part A when they become at the age of 65.
      • They must enroll in Part B or Medicare Advantage during open enrollment periods.
    • Medicare plans are available on HealthCare.gov or state health insurance marketplaces.
      • False
      • Medicare.gov is the designated site where seniors and others eligible for Medicare or Medicare Advantage can sign up or enroll for Medicare benefits. You can also call (800) MEDICARE (633-4227). You can go to HealthNetwork.com, as well.
      • You can contact a company offering Medicare Advantage plans any time to speak about switching to Medicare Part C.
    • Original Medicare is free, Medicare Advantage is not.
      • False
      • Original Medicare is like any other insurance plan, and there are costs. Out-of-pocket costs for Original Medicare include premiums, deductibles and copayments.
      • You pay a premium each month for Part B whether you have Original Medicare or Medicare Advantage.
      • Both plans have out-of-pocket costs, but Medicare Advantage plans have out-of-pocket spending limits.
    • Everyone pays the same for Medicare whether Original or Medicare Advantage.
      • False
      • Medicare costs vary, based on your income and what plan you choose.
      • Most people pay $104.90 for a Part B premium. Those with higher incomes end up paying more. But those with limited incomes and resources may qualify for further assistance that will let them avoid out-of-pocket costs.
      • Medicare Advantage plan premiums vary by plan and typically depend on the amount of prescription drug coverage you want.
    • Medicaid and Medicare are the same federal program.
      • False
      • Medicare and Medicaid are very different programs.
      • Medicare is health insurance for the elderly, disabled and individuals with end-stage renal disease or ALS (Lou Gehrig’s disease).
      • Medicaid is health insurance for individuals and families with limited income and resources. Medicaid typically covers individuals who fall below a certain percentage of the Federal Poverty Line.
      • Children are covered under the federal healthcare program known as CHIP, which is an extension of Medicaid.
      • College students may receive healthcare from Medicaid.
    • Payments to health insurance companies offering Medicare Advantage are increasing.
      • True
      • The Affordable Care Act made more than $200 billion in cuts to Medicare Advantage payments that will be phased in each year.

    Medicare Advantage myth #1 – Medicare Advantage is separate from Medicare

    Know your coverage. Never assume or tell your doctor that Medicare covers you until you have checked your plan. It is important to note that once you have selected a Medicare Advantage (MAP) plan, your private insurance company possesses your Original Medicare benefit. They become responsible for your coverage through plan administration and payment of claims. Through MA, you become the owner of a commercial policy equivalent to Original Medicare. And, you are subject to all guidelines and limitations set forth by that plan.

    As a general rule, you will find that most medical offices accept Medicare. However, this is not the case with Medicare Advantage. Due to payment skepticism, providers are more reluctant to contract with Medicare Advantage.

    Additional constraints and paperwork complications only magnify the reluctance. The ACA changed some limitations facing Medicare Advantage. But you still should check with your medical care providers if a Medicare Advantage Plan would be acceptable. In some cases, you may also have to switch to a new primary care doctor if you go with Medicare Advantage.

    Under Medicare Advantage, the federal government no longer pays your claim for the Medicare benefit. When visiting your doctor, it is important that you inform the office staff prior to your appointment and use medical cards issued by your insurance carrier.

    Medicare Advantage myth #2 – Conditions and terms vary

    Medicare Advantage does not function on the same simple, “Fee For Service” principle employed by Original Medicare. However, they are required to offer the same coverage. This would include doctor visits, in- and outpatient services, emergency and preventive care. It also includes tests and labs, mental health and limited physical therapy.

    Additionally, MA must also provide limited services for home or nursing care. Some medical supplies and drug and alcohol treatments are also included and, they can provide additional services that include dental, vision and hearing part D. This is one of the biggest draws of Medicare Advantage. MA plans with the highest ratings typically have extra services, like vision, dental and hearing.

    The confusion surrounding Medicare mostly has to do with political views and misrepresentation in the media. Medicare makes it so that those who need affordable healthcare can receive it automatically at a certain age or if they have a certain disability. It’s not a free program, but it is lower-cost and does cover the basic medical services that most people need. It may not be the best option for long-term healthcare or help with chronic illness.

    Now that you understand a bit more about Medicare, you should also differentiate between the types of Medicare Advantage plans available to you.

    Two basic Medicare Advantage plans: HMO and Non-HMO

    Medicare Part C plans break down into different types that you can most commonly refer to as HMOs and non-HMOs. While some people prefer HMOs, because they are generally lower-cost, non-HMOs may allow you to see more doctors and hospitals that aren’t in a specific network.

    HMO:

    Patients must receive medical services through the network. Based on geographical location, patients enroll with their appropriate independent practice association (IPA) or medical group. They are also assigned a primary care physician (PCP), who is responsible for oversight of medical care, specialist referrals and issuance of authorization for service.

    There are choice and specialist limitations, and Part D must be purchased through the same network. While you receive additional coverage with Part D, you still must pay a premium to cover Part B.

    Non-HMO (FFS or PPO):

    This plan does not have the same restrictions as the HMO. However, it is important to note that services rendered outside the network or by noncontracted doctors can cost significantly more money. Medical professionals inside the PPO network may not necessarily accept MA patients.

    PPO plans are technically commercial plans. Therefore, it is wise to use caution when using “PPO” or “FFS” terminology in the context of Medicare. Also note that Plan D can be purchased from a separate, non-HMO insurer. You still must pay for your Part B premium, in addition to a monthly premium for a non-HMO plan.

    Medicare Advantage myth #3 – The possibility of higher cost sharing

    Many people switch to MA plans, only to find they no longer have access to their doctor or coverage for unexpected costs. But, prescription coverage proves very beneficial, as they do not require the standard 20 percent Medicare copay and restrictions on yearly cost shares.

    However, deductibles, copays and out of pocket costs may be higher than Original Medicare. This ranges, depending on the Medicare Advantage plan and health insurance carrier. Some plans do try to combine different services into one plan to offer more benefits, which can lead to a higher premium per month, but a lower copay.

    Medicare Advantage and commercial policies also offer a greater range of plan choice, at potentially higher premiums, compared to Original Medicare, which only offers a single plan. To expand your Original Medicare coverage, you would have to purchase supplemental coverage, including a separate plan, called Medigap, and another plan for prescription drug coverage.

    Choosing Original Medicare or Medicare Advantage

    Medicare isn’t just for individuals over the age of 65. As such, there are a lot of people who have questions about how to get Medicare Advantage or Part C coverage, in addition to Original Medicare. Those who have paid into Social Security for several years automatically qualify for Medicare at the age of 65; you also start receiving Social Security payments. While Original Medicare is covered in Part A and B, Medicare Advantage is available in Part C. Understanding the differences between these plans can give you more robust healthcare coverage at a lower cost. However, it still depends on your medical care needs.

    Choosing between Original Medicare and Medicare Advantage comes down to what you want in a health insurance plan. While Original Medicare may not have extras, it’s more flexible as to what doctors you can see. One thing to consider is that the same services you receive under Original Medicare will also be included in any Medicare Advantage Plan.

    By taking a look at what’s offered in these plans in-depth, you learn the costs, coverage and problems associated with each type of healthcare before open enrollment.

    What’s covered in Medicare Part A and Part B

    Original Medicare is known as Part A and Part B. Part A covers expenses from hospitalization. Part B covers bills from doctors and other expenses, such as lab work and preventive screenings. You may still have to pay a premium in order to use these Medicare plans. But in most cases, Part A is free, and you’ll pay a premium for Part B. Currently, the premium is $104.90.

    What’s covered in Medicare Advantage or Part C plans

    Many individuals interested in Medicare actually find that Medicare Advantage plans are better, because of the flexibility and choices when it comes to plan types and extra services. These plans are offered through private health insurance companies, rather than through the government. They must cover the same services in Part A and B. But they also include extra coverage for things like prescription drugs, vision, dental and hearing.

    The crucial difference between these two is that you don’t have to purchase any supplemental insurance plans to get extra coverage and prescription drugs if you choose Medicare Advantage. With Original Medicare, you will pay extra and have to add separate plans, like Medigap and Part D coverage, in order to get all of the coverage that you need.

    Comparing the costs of Original Medicare and MA plans

    Most Medicare Advantage plans cost the same or much less than Original Medicare, with supplemental coverage extras. Then there are some Medicare Advantage plans that offer more services, but also have a higher premium. In 2015, the average premium cost for Medicare Part B is $104.90, which is taken out automatically from Social Security.

    If you have ever bought a private health insurance plan on your own, then you will understand how to purchase Medicare Advantage plans. They are offered separately from other plans and can be compared easily on most sites like HealthNetwork.com.

    Each Medicare Advantage plan will offer a different monthly premium, coinsurance, copay and out-of-pocket limit. If you do end up with a lower premium for Medicare Advantage, you may have to pay a higher copay when you visit a doctor or facility.

    Typically, studies have shown that Medicare Advantage plans cost no more than Original Medicare plans. And, they still offer more freebies and extra services, because private companies provide them.

    Breaking down coverage in Medicare and Medicare Advantage

    When considering which plan to purchase, you should learn about the basics of coverage for each type of plan. This is a quick look at all of the differences between the two and how each of them work. As the federal government sponsors them both, there are certain limitations to the coverage.

    What is included in Original Medicare plans

    These plans are for Part A and B. They do not include Part C or Part D. Original Medicare is completely offered through the federal government. You can use this type of Medicare everywhere that Medicare is accepted.

    • Part A and Part B are included if enrolled for both.
    • You pay a coinsurance and deductible when you receive healthcare. Medicare typically expects you to pay 20 percent of the cost for outpatient care.
    • Most enrollees must pay a premium for Part B. There aren’t any premiums for Part A if you have worked in the United States for 10 years.
    • You can receive medical care from any hospital or doctor who accepts Medicare in the U.S.
    • You don’t need a referral to see a specialist.
    • No pre-authorization is needed to get services.
    • You are covered for Medigap policies if you want supplemental insurance.
    • To get prescription drug coverage, you have to buy a separate plan from a private insurance company.

    What is included in Medicare Advantage plans

    Plans are sold by private companies approved by Medicare. Plans include Part A, Part B and typically, Part D (prescription drug coverage). However, some companies choose to sell this coverage separately.

    • These plans have to cover the same benefits in Part A and Part B.
    • Some companies provide extra benefits not included in Original Medicare.
    • Plans vary by type with Medicare Advantage. Popular plans include HMOs, PPOs and PFFS.
    • Under Medicare Advantage, you still receive Medicare, but it’s not called Original Medicare. You have a private plan, with varying costs and restrictions set by a private company.
    • Enrollees pay a fixed copay ; there may be a deductible, as well.
    • You pay the same premium price as you would for Medicare. But in some cases, you pay extra for services added to a Medicare Advantage plan that are not included in Original Medicare.
    • If you have an HMO, you must see doctors and hospitals that are in the network.
    • You may have to choose a specific primary care physician and get referrals or prior authorization to see other doctors and specialists.
    • Medigap policies are not available to you.
    • Plans do limit the amount of out-of-pocket cost. After you reach these limits, you don’t pay anything.
    • Medicare Advantage plans offer Part D (prescription drug coverage); these are often called MA-PD plans.

    It may seem that Original Medicare is cheaper. But the costs may be more advantageous in Medicare Advantage, if you want to pay a little extra for additional flexibility and services. Vision, dental, hearing and wellness programs may be provided in Medicare Advantage, but are not typically available in Original Medicare.

    How to switch to or from Medicare Advantage plans

    If you currently have Original Medicare and you want Medicare Advantage, you can make changes to your Medicare coverage during open enrollment periods. You can follow these rules to enroll or change plans with Original Medicare and Medicare Advantage.

    1. You can only switch Medicare Advantage plans and Original Medicare Plans during the Fall Open Enrollment that starts October 15 and ends December 7. New coverage starts January 1. During this enrollment period, you can make changes to your coverage, including adding, dropping or switching plans.
    2. You can move back to Original Medicare during a Medicare Advantage Disenrollment Period (MADP). This period starts January 1 and runs through to February 14 each year. Any changes made will start effectively during the following month. If you decide to switch back and have a stand-alone drug plan, you will keep your drug plan.
    3. You may be able to qualify for a special enrollment period. These special enrollment times allow you to change health plans or add drug plans outside of the typical enrollment or disenrollment periods. You can qualify if a Medicare Advantage plan leaves your area or if you move from your plan’s service area. There’s also a special enrollment period if you want to switch to a 5-star Medicare Advantage plan from a current, lower-score plan.

    Do you need a Medigap policy?

    A Medigap plan is a supplemental insurance plan that you get from a private company to pay costs that aren’t covered in Original Medicare. These costs may include deductibles, copayments and medical services received outside of the U.S. Medigap is an add-on for Original Medicare only and does not work with Medicare Advantage.

    Many people require supplemental coverage, because they only receive the basic services under Original Medicare and are paying high out-of-pocket costs. Medigap tries to shrink the coverage gap. But you also have to pay another premium and deductible to have this supplemental coverage.

    Medigap doesn’t cover long-term care, dental, vision, hearing and wellness programs. They also do not cover prescription drugs, in most cases.

    Medigap policies have a premium. If you frequently need services that are not provided in Original Medicare, but don’t want to switch to Medicare Advantage, Medigap may be the best choice. However, these plans are only available to people who already have Part A and Part B.

    If you are currently on Medicare Part C, you won’t qualify for Medigap. There are standard Medigap plans that range from A through N. Then, there are Plans E, H, I and J, which are only available to older subscribers of Medicare.

    If you choose Medigap plans, you still pay a premium. You’ll pay a premium for Medigap and a premium for Part B. The total cost of your plan will depend on the private company. It also depends on your age and location. If you pay your premiums on time, you can always renew your Medigap policy.

    Which Medicare plan is better for you?

    For those who rely on prescription drugs, Medicare Advantage is the best plan. Original Medicare does not provide any coverage for prescription drugs whether you have Medigap or not.

    Although you can add Part D coverage to an Original Medicare plan, there’s typically a much higher cost to do this. About 82 percent of Medicare Advantage plans already include prescription drug coverage.

    In addition, Medicare Advantage plans make it so there is a cap on out-of-pocket spending. No matter what, you can’t spend more money out-of-pocket after a certain limit. There is no out-of-pocket maximum for Medicare. This means that you can often pay more out-of-pocket. As of 2015, Medicare Advantage plans included a $2,960 cap or less for out-of-pocket expenses; in 2016, this amount increases to $3,310.

    If you don’t want to pay the 20 percent coinsurance with Original Medicare, you should also pick Medicare Part C. Medicare Advantage plans are structured differently and typically cost less for the value that you receive. You may be able to see more doctors and also pay a lower premium per month. And, you may only be responsible for copays when you visit a doctor or hospital.

    Under some Medicare Advantage plans, extra services are available. If you are looking for assisted living facilities, nursing home care, vision and dental, it’s best to pick a Medicare Advantage plan that already has those features built in.

    When Medicare Advantage (Part C) isn’t always best

    If you want to have a broad range of doctors, then you can find doctors and hospitals that accept Original Medicare and visit them for care at any time.

    In some cases, private Medicare Advantage plans do have an additional premium cost. If you want your cost to be as low as possible, then you should pick Original Medicare. However, this is only if you want the most basic coverage.

    If you are still employed and covered by an employer, then you should really get Original Medicare. You can pay higher premiums for choosing Medicare Advantage in these situations.

    Making the right Medicare choice

    The best way to pick between these plans is trying to estimate what you’ll need to see a doctor for and what types of services you require. By considering your medical history and speaking with your current doctor, you can get an idea of what plan will offer you the most choices for the value.  If you do decide that you want Medicare Advantage, you can only enroll between October 15 and December 17, the Open Enrollment Period. If you qualify, you may be able to get special enrollment.

    This website, HealthNetwork.com, along with others such as MedicareEnrollment.com, can provide you with a lot of information about Medicare Advantage plans. Finding an agent who can help you determine what plan is right for you is as simple as calling our toll-free number and speaking with one of our healthcare professionals.

    Or, if you would prefer to obtain some additional information from a government resource, you can always visit www.medicare.gov/ for more details. Medicare Advantage plans are ideal for a large segment of the population. But thorough research is still encouraged, as you will not be eligible to make plan changes for 12 months.

    However; you can join, switch or leave your MA plan as often as you like during open enrollment, which lasts from mid-October until early December. You may also join an MA plan during the year if you become eligible or the plan has a 5-star rating. But you can only leave your MA plan and rejoin Original Medicare between January 1 and February 14 of every year.

    Need help? Speak with a human.

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