Healthcare After 65 – Everything You Should Know About Medicare Advantage

Healthcare After 65 – Everything You Should Know About Medicare Advantage | HealthSoul

At a certain age, people start to realize that their health isn’t what it used to be and that their bodies have changed. While medical care isn’t always needed, more often than not, treatment is required.

It’s vital for anyone over the age of 65 to be aware of their medical coverage and limits. Below you’ll find the benefits of having a Medicare Advantage plan on top of the standard Medicare package.

What is Medicare Advantage?

These are health plans offered by private companies that contract with Medicare to provide a combination of Part A and Part B benefits. It’s most commonly known as Medicare Part C. You can learn more about Medicare Advantage plans here.

Many of the packages offer prescription drug coverage, which is essential for elderly individuals needing chronic medication. The product is most often provided to pensioners and disabled adults who qualify.

Even if you do join the Advantage plan, your standard government Medicare package is still valid.


What Is The Scope And Coverage Of Medicare Advantage

Medicare Advantage offers a scope that’s undeniably wider than the original Medicare. For example, Medicare Advantage plans now cover programs relating to fitness, vision, hearing, and dental. Depending on your needs, you can even choose to personalize your Advantage plan so it can have other inclusions as well.

Other add-ons that your Medicare Advantage plan can include would revolve around the following:

  • Transport services to and from the hospital;
  • Services to protect and promote your overall wellness;
  • Over-the-counter and prescription medication;

Why You Should Consider Medicare Advantage

The Advantage plans must offer you the same level of coverage as the original Medicare scheme. Most programs also provide extra benefits, which may include vision care, hearing aids, dental hygiene and care, and even a fitness center membership.

It might be best to choose a primary care physician. They will help coordinate your treatments within the system. The plans that include prescription drugs sometimes have medication therapy management included. This form of looking after your wellbeing is a valuable tool.

Your package can be tailor-made to suit your needs. If you suffer from a chronic illness, then an SNP Advantage plan can assist in covering the medical costs.

If you don’t want to be tied down to a network, you can consider different options, such as PFFS, for more flexibility.


Do You Still Get To Enjoy Medicare Coverage?

One of the more common concerns with those who wish to obtain a Medicare Advantage plan surrounds the question of whether or not with this plan, they can still get to enjoy Medicare advantage. The answer is in the affirmative.

The only difference lies in the fact that the Medicare Advantage doesn’t cover anything relating to hospice care. But, despite this, it’s also mandated that once you’re enrolled in a Medicare Advantage plan, but not yet in the original Medicare, the latter will be the one that’ll step in and cover your hospice care.

Limitations of Medicare Advantage

With great benefits come to some restrictions to be aware of when choosing a plan in your golden years.

The network of providers is limited, which isn’t ideal should your retirement goals consist of traveling. When you need to see a doctor not included in the network, you could pay higher fees.

There’s an overwhelming assortment of Medicare plans on the market. It can be intimidating and confusing to try and establish which one is best for your needs.

You can figure it out for yourself using a checklist, but we recommend seeing a consultant. One that specializes in these schemes can explain everything to you.

The idea of Medicare Advantage is to consolidate Part A, Part B, and Part D into one package for a lower premium. However, depending on the plan, you might find that there are some additional charges. Be aware of the costs of drug deductibles and specialist visit co-payments as these may add up.

Limitations of Medicare Advantage | HealthSoul

What Are The Rules In Using Medicare Advantage Plans?

It’s also important to tackle the different rules that apply when using Medicare Advantage plans. Remember that Medicare is paying a fixed amount to all of the companies that offer the Medicare Advantage plan. Hence, it’s just but right that all these companies must follow all of the rules set by Medicare.

For instance, some of these rules revolve around the following:

  • The out-of-pocket costs that can be charged by Medicare;
  • The question of whether or not your case has to be forwarded to a specialist;
  • The need to go to medical facilities that belong to this plan that are classified as non-emergencies or non-urgent.

Along this line, it’s very important for you to check and review the provisions of your Medicare plans yearly as these can be subject to annual change.

Different Types of Medicare Advantage Plans

To get a better idea of the different types of Medicare Advantage products available, take a look at the list of plans below:

  • Preferred Provider Organization (PPO) – A perfect choice for seniors over 65 who want the freedom to choose any doctor who accepts Medicare cover. If you plan to travel, this is a good option.
  • Private Fee-for-Service (PFFS) – It determines coverage upfront and how much you’ll pay for certain treatments. However, it doesn’t absorb the costs of a doctor that doesn’t agree to the terms and conditions.
  • Health Maintenance Organization (HMO) – This is the most common one which allows you to use practitioners within it’s stipulated network of providers.
  • Special Needs Plan (SNP) – An option for people with certain conditions such as diabetes, HIV/AIDS who live in institutions and have dual-eligibility for Medicare and Medicaid.
  • Health Maintenance Organization Point of Service (HMO-POS) – This package covers in and out of network services at different rates. If you go to an in-network medical professional, you’ll pay less out-of-pocket fees.
  • Medical Savings Account Plan (MSA) – This plan has a high deductible, and to help you pay for that, you’ll get a savings account. The amount deposited varies between policies.

Different type of Medicare Advantage Plans | HealthSoul

Final Thoughts

Without a doubt, good quality healthcare is of vital importance at any age, but after 65, it’s crucial. Medicare covers many different illnesses; however, it might not be enough for chronic conditions as you get older. This is where Medicare Advantage comes into play.

Do your research carefully and decide which type of plan would benefit you the most. Make use of a consultant if you’re confused about the various options, and be aware of package limitations.

Putting in the effort to choose the right plan will save time and energy in the long run, especially when you require treatment.