Medicare is a health insurance package sponsored by the federal government. Unlike Medicaid, which focuses on low-income individuals who meet certain criteria, Medicare is offered to adults who are either over the age of 65, living with disability, or suffering from end stage renal disease.
Medicare comes in four different parts, starting with Part A that covers hospital expenses. Part B covers medical expenses, which can include medical equipment, doctor visits, and labexaminations, while prescription drug coverage comes in Part D. Additionally, individuals can get all three parts under a single package, which is called Medicare Advantage, or Medicare Part C. Rather than being paid for by the state, Medicare Advantage plans are offered by private service providers. Despite providing more coverage, Medicare Advantage plans tend to cost less than traditional Medicare, though there are a few drawbacks. Below, we’ll list the three advantages and three disadvantages that come with Medicare Part C.
Pro: Cheaper Drug Coverage
Most Medicare Advantage plans will include Medicare Part D. Deductibles for prescription drugs under a Medicare Advantage plan will usually be lower than in standard Medicare Part D plans. In 2020, the deductible amounted to $121 for Medicare Advantage, versus $435 for Medicare Part D. You might be limited in your choice of drugs, so be sure to check whether your plan includes the prescriptions you need.
Pro: Added Benefits
Medicare Advantage plans often come with added benefits not covered in traditional Medicare. Kelsey Care Advantage shows that dental, vision, and fitness coverage are some of the things a Medicare Advantage benefits package can include. These benefits let you take better care of your health as a whole while reducing expenses and saving you the effort of having to research services.
Pro: Out-of-pocket Spending Limit
Thanks to the Affordable Care Act, Medicare Advantage plan providers are legally obligated to set dollar amount limits on out-of-pocket medical expenses. This limit can vary depending on your provider but generally falls between the $3,000 to $6,000 range. If your spending exceeds your provider’s out-of-pocket spending limit, you will no longer be charged for any medical expenses for the rest of the calendar year. There are no such limits in traditional Medicare. Therefore, Medicare Advantage might prove useful to individuals expecting to spend heavily on medical expenses.
Con: Limited Network Coverage
Medicare Advantage Plans save money by sourcing services from limited provider networks. Many providers will charge patients extra fees for enlisting out-of-network services. If your healthcare needs require the insight of many different specialists, these networks could limit your options for treatment.
Con: Lack of Portability
Your network might be limited to a certain service area. Should you move or travel, your Medicare Advantage Plan will not travel with you. In fact, if you continuously travel outside of your provider’s service area for over six months, your provider may automatically disenroll you. The majority of Medicare Advantage providers will not cover even emergency expenses for those traveling outside the United States.
Con: Need for Doctor’s Referral
Healthline notes that patients enrolled in a Medicare Advantage plan cannot seek the services of specialists unless they secure a referral from a specialist. Having a middleman between you and specialist services can cause delays when seeking treatment. For example, if you’re concerned about your heart health, you’d only be able to secure an appointment with a cardiologist after a meeting with your primary care physician.
Compared to traditional Medicare, Medicare Advantage can offer more coverage at a lower cost. However, the lack of flexibility in their limited provider networks might keep you from getting the treatment you really need. Before deciding on a health insurance package, make sure to determine whether their features align with your specific healthcare needs.
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