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Understanding Medicare Senior Advantage Care Plans: What They Are and Why They Exist

Updated: Dec 19, 2022


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Medicare Advantage plans are an important part of the health care system for seniors. These plans provide coverage for routine and preventative care, as well as for hospitalization, inpatient services, and prescription drugs. A Medicare Advantage plan is designed to help seniors get the care they need in a cost-effective manner.


Advantage plans are offered by private health insurance companies and approved by the federal government. Seniors enroll in a Medicare Advantage plan to get the same coverage as traditional Medicare but with additional benefits such as dental, vision, hearing, and health and wellness programs.


They also have the option to select a plan that includes coverage for prescription drugs or a plan that is strictly for medical coverage. Understanding the different types of Medicare Advantage plans and the benefits they offer is important for seniors so they can make an informed decision about their healthcare coverage.

What is a Medicare Advantage plan?


A Medicare Advantage plan is a type of health insurance plan that seniors can use as a replacement for traditional Medicare coverage. Medicare Advantage plans are offered by private health insurance companies and approved by the federal government. Seniors enroll in a Medicare Advantage plan to get the same coverage as traditional Medicare but with additional benefits such as dental, vision, hearing, and health and wellness programs.


They also have the option to select a plan that includes coverage for prescription drugs or a plan that is strictly for medical coverage. Medicare Advantage plans are a type of managed care plan and employ strategies such as utilization review and case management to lower the cost of care for seniors.

What benefits do Medicare Advantage plans offer?


While all Medicare Advantage plans offer the same core benefits as traditional Medicare, seniors have the option to select a plan that offers additional benefits in the following categories: Dental - Medicare Advantage plans generally offer dental coverage with a $0 monthly premium. Vision - Seniors can choose to pay a monthly premium to add vision coverage to their Medicare Advantage plan.


Hearing - Medicare Advantage plans commonly cover hearing aids and audiograms.

Health and wellness programs - Medicare Advantage plans offer wellness programs such as classes and seminars on health and wellness topics.

What types of Medicare Advantage Plans are available?


There are four types of Medicare Advantage plans: Health maintenance organization (HMO) Plans - Medicare Advantage HMO plans are generally limited to services that are provided within a specific network of providers. Preferred provider organization (PPO) Plans - Medicare Advantage PPO plans give seniors the ability to choose their providers, but they must pay a higher monthly premium than HMO plans.


Special needs plans (SNPs) - SNPs are designed specifically for seniors with special health care needs, such as those who are wheelchair-bound or suffer from other disabilities. Medicare Medical health maintenance organization (MM-HMO) Plans - MM-HMO plans combine features of both HMO and PPO plans.

How does Medicare Advantage work?


Seniors who enroll in a Medicare Advantage plan receive the same benefits as those who enroll in traditional Medicare. Seniors are also required to pay monthly premiums for Medicare Advantage plans.


In exchange for their monthly premium and a small copayment for certain services, they can access the full range of Medicare Advantage plan benefits. Seniors who choose to enroll in traditional Medicare must pay their full monthly premium and a larger copayment for any services covered under their plan.

What are the pros and cons of enrolling in a Medicare Advantage plan?


Advantages of enrolling in a Medicare Advantage plan - Seniors can access a wider selection of health care providers with a Medicare Advantage plan than with traditional Medicare. Seniors can also use their Medicare Advantage plan to access prescription drug coverage and vision and dental coverage if they choose the appropriate plan.


Disadvantages of enrolling in a Medicare Advantage plan - Medicare Advantage plans have stricter rules than traditional Medicare. Seniors enrolled in Medicare Advantage plans must stay within the plan’s provider network in order to receive coverage for medical services. Seniors who choose traditional Medicare can choose any providers they like.

What should I consider when choosing a Medicare Advantage plan?


- Do you want to enroll in an HMO, PPO, or SNP?

- Are you willing to pay a higher monthly premium for extra benefits, such as dental and vision? - What is the cost of each plan? - What is the quality of the plan?

- What providers and facilities are covered by the plan?

- What are your health care needs and goals?

- What are the eligibility requirements for enrolling in a Medicare Advantage plan?

- What happens if I don’t enroll in a Medicare Advantage plan?

What are the costs associated with Medicare Advantage plans?


Monthly premiums - Seniors who enroll in Medicare Advantage plans must pay a monthly premium. The monthly premium varies depending on the type of Medicare Advantage plan a senior selects and the person’s income and assets.


Copayment - Seniors who enroll in Medicare Advantage plans must also pay a copayment for certain services. The amount of the copayment is based on the type of plan a senior selects. Deductible - Medicare Advantage plans do not require a deductible.


In-network services - Seniors who enroll in Medicare Advantage plans can use their coverage to receive services from providers within their plan’s network.

Out-of-network services - Seniors who enroll in Medicare Advantage plans and use out-of-network providers must pay the full cost of their services.

What are the eligibility requirements for enrolling in a Medicare Advantage plan?


To enroll in a Medicare Advantage plan, seniors must first enroll in traditional Medicare. They must also meet all Medicare eligibility requirements, such as being a U.S. citizen or permanent resident, and must not be on any federal or state healthcare financial assistance programs.

What happens if I don’t enroll in a Medicare Advantage plan?


Seniors who don’t enroll in a Medicare Advantage plan will continue to receive traditional Medicare coverage. Seniors who choose not to enroll in Medicare Advantage plans may receive lower reimbursement rates for their medical services than those who do enroll in a plan.

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What resources are available to help me understand Medicare Advantage plans?


As you consider your options for Medicare Advantage plans, it’s important to understand all the details. You can use the information in this article as a starting point, but you can also find additional resources to help you make an informed decision. You can also speak with an insurance agent or a financial adviser to help you find the best Medicare Advantage plan for your health care needs.


Weigh the benefits of enrolling in a Medicare Advantage plan as opposed to the traditional Medicare plan. Cost and payment options are important for seniors who are living on a fixed income and can only allocate a certain amount each month for healthcare services. Distance and proximity to the nearest healthcare provider or network are also important, and for most seniors, this is vital for preventive healthcare services long-term.


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