What is Medicare Advantage?

Everyone needs a health cover, but as you age, your need for medical insurance increases. The federal government came up with the Medicare plan for seniors above 65. Shopping for insurance is not an easy task. It becomes even more laborious when it is for an elderly individual with specific medical needs. While the original Medicare may be sufficient for some people, others may have to look for more comprehensive plans.

When shopping for any health cover, it is important to consider factors such as; the affordability, the institutions you can visit, if there are any emergency care conditions and the quality of care you will receive. You can also consider whether you get medical aid when you travel and even if the package includes prescription drugs. Medicare is not any different.


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What is Medicare Advantage? It is part C Medicare; it is more comprehensive than Part A and B but not independent. The government outsources the plan is to private insurance providers, but the still regulates it. We will discuss more of its features as well as compare it to Medicare. It is my hope that after reading this, you will have an easier time making a decision.

How Does The Original Medicare Work?

what is medicare advantageOriginal Medicare is health insurance cover that the Federal Government issues to seniors over 65 years. If you have permanent kidney failure or are already receiving social security from the Railroad Retirement Board or Social Security Administration, you are also eligible. Persons receiving disability insurance also qualify even when they haven’t attained the age of 65.

Everyone pays about 1.45% from what they earn to the Federal Insurance Contribution Act which partly funds Medicare. Your employer also matches your payment, and hence Medicare Part A is free for those who have been working for the past ten years. You will pay a premium if you have been working for less than ten years.

Medicare Part A covers hospital insurance, that is, inpatient hospital care, services of a skilled nursing institution and in some very instances, home care. The cover also caters to hospice care. With part A, you do not get access to a private room unless your condition necessitates it. It even does not cover personal use items like razors.

You have to enroll in Part B of Medicare and pay a premium. Part B is medical insurance and covers doctor’s visits, flu shots, lab tests, outpatient and medically necessary x-rays. It also caters for durable medical equipment, for instance, crutches and walkers. To access prescription drugs, you need to enroll in Medicare Part D.


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What is Medicare Advantage And How Does It Work?

The Part C plan, also known as the Medicare Advantage, is provided by private health insurance providers contracted by the Federal government. Legally, what is Medicare Advantage must at least offer services similar to Part A and Part B. You must have original Medicare Part A and B to apply for Medicare Advantage. You will then pay a premium in addition to the one you pay for part B. If you have end-stage renal failure, you may not be eligible to join, but you can speak to your insurance provider about your options.

There are several plans which include; Health Maintenance Organization (HMO), which allows you to access medical care only from facilities in the program network, it is also the most affordable. Preferred Provider Organization (PPO) with this one, you pay less for services from doctors within the network and a bit more for other doctors and facilities.

Special Need (SNP), this one covers particular persons such as those living in nursing homes and those with chronic conditions. The Private Fee for Service (PFFS) plan work almost like the original Medicare. Your insurance provider decided how much the services you acquire should cost and pays a percentage of the amount. Then there is Medical Savings Account (MSA), here medicare combines you deductibles with a bank account. Your insurance provider deposits an amount, mostly, less than deductible in the account and you can use it for health services within the year.

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How Can You Differentiate Original Medicare and Medicare Advantage?

The original Medicare does not have an out of pocket maximum. The lack of a ceiling means that no matter how many times you pay coinsurance, deductibles and copayments, there will never be a reprieve for you. However, with Medicare Advantage, there is an amount that after you have spent it, the cover will pay for most of your medical care without requiring you to top up.

When using Medicare, you will need to either get Medigap or purchase part D separately to have access to prescription drugs. Medicare Advantage has comprehensive packages that can cover prescription medications on their own. Medicare Advantage plan can also include conditions that Medicare will not, for instance, dental and optical services.

In most instances, you will be automatically enrolled in the Medicare part A and will just need to apply for part B. Medicare Advantage is optional. The benefits of Medicare Advantage may also change with time, and you need to keep yourself abreast with how your insurer works.

Will Original Medicare or Medicare Advantage Work For You?

Once you are 65 years and older, or your parents for that matter get to that age, their bodies become almost brittle. Sprains, fractures, eye impairments and other illnesses become everyday occurrences. It is imperative when choosing an insurance plan to consider all these factors. You need a cover that will let you sleep easy knowing you can always count on it whenever you health or that of your loved ones dictates.

The original Medicare gives you the benefit of a free part A and a premium part B. You, however, need to subscribe to part D to get your medication. Further, you do not get blood in the package, and if you need it, you have to pay for the first three pints of blood. The cover also does not cover those ailments common in seniors, such as dental appointments and even access to eyewear.

Medicare Advantage may cost you a little more regarding premiums, but that extra cost goes a long way in ensuring your peace of mind. What is Medicare Advantage? It is that additional care that your loved ones need. It is the assurance that the more you use healthcare facilities, the more your out-of-pocket payments reduce.  The cover also caters to emergency care outside your plan area to ensure you never miss attention regardless of your particular location.


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