Senior reviewing medicare plans

Is Medicare Advantage Right For Me?

Medicare Advantage will be a good choice for you if you are looking for a bundled plan with an out-of-pocket maximum and a network of providers in your region.

Who is Medicare Advantage Good For?

Medicare Advantage is a good choice for people who want something affordable with coverage local to their region. Often, people will choose to either remain with Original Medicare and add a Medicare Supplement or they will choose to switch to a Medicare Advantage plan. Medicare Supplement plans can have pricey monthly premiums, which makes Medicare Advantage plans a better option for people with few health concerns who are on a budget.

What to Know About Idaho Medicare Advantage Plans

Medicare Advantage plans are plans offered by private health insurance companies which have been approved by Medicare to handle your Part A and Part B coverage. 

These plans sometimes come with optional packages for routine dental, vision, or hearing care, which you can purchase with an additional monthly premium. Some plans, called Medicare Advantage Prescription Drug (MA-PD) plans, have built in Part D equivalent prescription drug coverage. Instead of purchasing separate supplemental insurance for these gaps in Medicare coverage, you can purchase your policies from one insurance company and pay one bill each month for all of your healthcare coverage.

Medicare Advantage plans in Idaho come in several different forms. There are HMOs, PPOs, PFFSs, and SNPs. Health Maintenance Organizations (HMOs) are best compared to Preferred Provider Organizations (PPOs). HMOs and PPOs both use networks of providers, but people with PPOs can see providers outside of their plan’s network. With an HMO, you need to have a primary care physician and get a referral from your doctor to see a specialist, while with a PPO you do not need either of those things.

Private Fee-for-Service (PFFS) plans are more peculiar. More common in remote areas, these plans may or may not have networks of providers. With a PFFS plan, you can see any provider who agrees to treat you and accepts your plan’s payment terms.

Special Needs Plans (SNPs) are made for specific groups of people. There are three types of SNP: Chronic Condition (C-SNP), Dual Eligible (D-SNP) and Institutional (I-SNP). These plans have networks of providers that specifically treat these conditions, accept Medicaid, or care for the needs of institutionalized people.

Benefits of Medicare Advantage

Medicare Advantage plans have an out-of-pocket maximum limit, meaning once you have paid a certain amount toward copays and coinsurance, your insurance company will step in. After you reach the maximum, your insurance company will cover your healthcare costs for covered services for the rest of the year.

Disadvantages of Medicare Advantage

While under Original Medicare, you can see any healthcare provider that accepts Medicare. With a Medicare Advantage plan, you are more restricted. Most plans work with a network of healthcare providers, and if you see someone outside of that network, you can count on paying much more. If a provider does not accept your plan, they are only required to treat you in an emergency medical situation.

Choosing a Medicare Advantage plan in Idaho

To choose a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Part B and live within the plan’s service area. Then you should decide whether or not you want a plan with prescription drug coverage. If dental, vision, hearing, or a health club membership are important packages to you, you can seek out plans with those benefits available.

For more assistance in choosing a Medicare Advantage plan in Idaho, contact Generations Insurance.