An Overview of How Medicare Advantage Works

Like millions of Baby Boomers retiring, you’re looking at your how to finance your healthcare needs. You’re eligible for Original Medicare coverage, which covers many important healthcare services, including hospital stays, doctor visits, and prescription drugs. But there is also another option that most retirees can select: A Medicare Advantage plan, also referred to as Medicare Part C.

Medicare Advantage plans cover the same services as traditional Medicare, but the way in which the plans work is slightly different from what those covered under Medicare’s regular Part A and Part B plans. Also, additional coverage may be available. With Medicare Advantage, the insurance company basically agrees to provide all of the ordinary benefits under Part A hospital and inpatient coverage and Part B outpatient care, and in exchange, you may pay additional premiums to the insurer in addition to what you pay Medicare directly for regular Part A and Part B premiums.

There are different types of Medicare Advantage plans available from various healthcare providers including HMOs, PPOs and fee-for-service plans. Often, Medicare Advantage plans offer prescription drug coverage as part of their overall insurance package. If a particular plan doesn’t have drug coverage, though, you can use Medicare Part D to cover prescription costs.

The Basics of Medicare Advantage

  • Medicare pays a fixed amount for your coverage each month to insurers offering Medicare Advantage Plans.
  • The insurers must follow rules set by Medicare.
  • Each Medicare Advantage Plan can charge different out-of- pocket costs (copayments, coinsurance, deductibles) and have different rules for how you get services. For example, some plans might require a referral before seeing a specialist. Other plans may require you to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care. What’s important to know is that these rules can change each year and the provider must notify you of any changes before the next enrollment year begins.
  • There are certain established enrollment periods in order to enroll in a Medicare Advantage plan.

Is Medicare Advantage Right for You?

Medicare Advantage plans cover everything that Original Medicare does, but they can also include additional coverage such as vision, hearing, dental and other health and wellness programs. You can also choose particular plans tailored to your own individual needs. If a plan offers better benefits for a specific treatment, it might be perfect for you and greatly reduce the total amount you have to pay for healthcare. And you have the flexibility in being able to switch plans each year, which can result in substantial savings.

At Omaha Insurance Solutions, we’ll help you take a close look at the Medicare Advantage plans available and assist you in deciding whether they’re the best choice to meet your healthcare needs.

Everyone Is Unique.

The right Medicare plan is the one with which you’re most comfortable. We’ll help you make this important choice by reviewing all the details of each plan with you. To speak with a licensed independent agent, give us a call at Omaha Insurance Solutions at 402-614-3389 TTY 711.