Why Medicare Advantage Plans are Important for You?

Posted by on Jan 14, 2019

Medicare Advantage plan is a type of private health insurance offered by private companies approved by Medicare. It allows you to get all the benefits covered under Original Medicare (Part A and Part B) except hospice care and additional benefits and services in a single plan. That’s why many medical beneficiaries choose Medicare Advantage plans in Texas over Original Medicare.

So why Medicare Advantage plans is important for you? Let’s find out.

Include Part D coverage

Original Medicare only covers Part A (hospital coverage) and Part B (medical coverage). It does not cover Part D. Most Medicare Advantage plans include Part D (Medicare prescription drug coverage) often for no additional premium. Therefore, when choosing your Medicare Advantage plan, you should carefully read all the benefits and services covered in the plan.

Additional healthcare coverage

Medicare Advantage plans also offer additional health care coverage including regular dental care, vision care, hearing aids, wellness services, fitness club membership, and weight counseling whereas Original Medicare does not offer these services. On average, original Medicare covers only about half of the healthcare expenses. Therefore, enrollees have to buy Medicare supplement plans to cover gaps in original Medicare.

Maximum out-of-pocket limit

This is the major perk of Medicare Advantage plans in Texas. Every Medicare Advantage plan has a maximum out-of-pocket limit. After reaching a certain fixed amount, you will not be charged for anything. Your insurance company pays for all the expenses of covered services. Original Medicare does have an out-of-pocket maximum. You have to pay your share all the way which may lead to financial disaster.

Save money

Original Medicare covers many things but not everything. Therefore, enrollees buy additional private insurances and plan to cover gaps in original Medicare, and for these additional plans, you have to pay the extra premium. You have to pay the monthly premium for your original Medicare, part D plan, and Medigap policy. On the other hand, Medicare Advantage plan covers all the benefits and services in a single plan. Medicare Advantage plans can save you plenty of money and cover all the benefits. Medicare Advantage plans usually have lower monthly premium than original Medicare plus Medigap.

These are the four key benefits of Medicare Advantage plans.

Types of Medicare Advantage Plans

Medicare Advantage plans in Texas is of different types, and each plan has different benefits, healthcare coverage, services, and costs. But every plan must provide original Medicare benefits. Following are the different types of Medicare Advantage plans:

Health Maintenance Organization (HMO) Plans

In the HMO plan, you can only go to doctors, hospital, and other healthcare providers in the plan’s network. Most HMO plans required you to get a referral from your primary doctor for tests or to see a specialist.

Preferred Provider Organization (PPO)

In PPO plans, a medical beneficiary pays less to use doctors or other healthcare specialists in the plan’s network. If you visit a doctor, hospital or specialist outside the plan’s network, you have to pay the full expenses.

Private Fee-for-Service (PFFS)

This plan is similar to original Medicare. You can go to any doctor or hospital that accepts plan’s payment terms. Your Medicare Advantage plan will determine how much you will pay to the doctor or other healthcare providers for healthcare services. You do not require referrals from a primary doctor for treatment by specialists.

Special Needs Plans (SNPs)

SNPs are designed for a specific group of people those who have a specialized health need, eligible for both Medicaid and Medicare, living in a nursing home or have certain chronic mental conditions.

HMO Point-Of-Service (HMOPOS)

HMO Point-of-service plan is slightly different than an HMO plan. It allows you to visit a doctor, specialist, or hospital out of the plan’s network at higher out-of-pocket cost.

Medical Savings Account (MSA)

This plan is less common plan than other types of Medicare Advantage plans. Medicare deposits a certain amount in your bank account which you can use for your healthcare expenses throughout the year.

You can choose your Medicare Advantage plans in Texas after weighing all the pros and cons of every plan.