Understanding Medicare Advantage
Selecting the right insurance can be challenging – with so many factors, it can be difficult to know where to begin. It’s true that what’s right for your neighbor may not fit your needs, so it’s important to inventory your lifestyle, health and budget and see how they align with the options at hand. When choosing between Medicare and Medicare Advantage, here are a few frequently asked questions that can help you on the path to determining what’s best for you:
What are the different options for Medicare?
If you’re 65 years old or have a qualifying health condition, you may enroll for original Medicare or a Medicare Advantage Plan (such as HMP or PPO). Medicare is a government-run health insurance program; on the other hand, Medicare Advantage is operated by private companies with the approval of Medicare. While both Medicare and Medicare Advantage encompass Medicare Parts A and B, Medicare Advantage is often referred to as Part C. There are also additional coverage’s available at an additional cost, such as prescription dug coverage ( part D) and other supplemental coverage.
What are the differences in coverage?
Both Medicare and Medicare Advantage cover Part A (inpatient hospital stays, care in a skilled nursing facility, hospice and some home health care) and Part B (certain provider services, outpatient care, preventative services and medical supplies). For Medicare, you have the ability to choose your providers who accept Medicare. For Medicare Advantage, patients must choose providers who are part of the insurance company’s network. Both options offer skilled care, but many Medical Advantage programs do not cover swing bed services (a higher level of care), and skilled care offerings vary and may not be available in your local community. Like in traditional health insurance plans, coverage in Medicare Advantage plans can very widely, so research your plan carefully before signing up.
What are the differences in cost?
Medicare typically covers about 80% of health care costs, and the patient is responsible for additional deductibles, coinsurance and other costs, in addition to a month premium for Medicare Part B. Premiums, deductibles, copays and more very for Medicare Advantage; further, if you choose and out of network provider, you may have to pay more or all of the cost of those services.
Is my doctor or hospital covered?
It depends. For original Medicare, patients have the opportunity to choose their providers, as long as those providers accept Medicare. However, Medicare Advantage coverage can vary significantly by insurer and by plan, and it’s possible that your current provider or hospital – or even health care in your community – my not be in-network for a given Medicare advantage plan. The Okeene Municipal Hospital does not accept all Medicare Advantage plans. Be sure to examine these details critically before enrolling to avoid potential limitations in term of access and coverage.
When can I change my enrollment?
Medicare Open Enrollment runs during the third quarter of each year, usually from specific dates in October through December. Check online or ask our health care providers for this year’s dates.
For more information to help determine the best approach for you, visit www.medicare.gov.