A Medicare Advantage Plan is an alternative to standard Medicare. This type of plan is administered by a private insurance company and covers hospitalization, medical, and other benefits in one centralized policy. Here, learn more about the components of a typical Advantage Plan and the benefits and drawbacks of having such a policy in place.

How They Work

Traditional Medicare covers 80 percent of hospitalization and medical bills. An Advantage Plan covers these same costs and provides additional coverage for prescription drugs and vision, hearing, and dental services. The exact coverage options can vary from policy to policy, but they always provide, at a minimum, the same coverage as standard Medicare. When you join an Advantage Plan, Medicare pays a specific amount each month to your plan provider, the same amount it would cover under its typical policy. Coverage costs over this amount are managed by the Advantage Plan provider, and they will charge commensurate premiums and copays. Out-of-pocket costs differ from one provider to the next. You might also need to follow specific plan rules, such as getting preapproval before seeing a specialist or seeking non-urgent medical care with health professionals who are part of the plan.

Pros

The biggest benefit of a Medicare Advantage Plan is the greater coverage it offers. Considering healthcare costs today, the standard 80 percent of regular Medicare can still leave a person with significant medical bills. An Advantage Plan can cover amounts over and above 80 percent, and provide coverage for vision, dental, medications, and more. There is also an ease and convenience with an Advantage Plan, giving you one policy for all your needs. As with other insurance types, bundling healthcare policies often results in more savings than you would have had if you bought each policy individually. Most plans have a vast network of providers, which helps streamline and better coordinate your care.

Cons

If an Advantage Plan policyholder has a favorite doctor who isn't an in-network provider, they will likely have to find a new doctor. This can be a significant drawback for people who have longstanding relationships with their providers. Another possible disadvantage is that there can sometimes be additional red tape to navigate with an Advantage Plan, such as obtaining preapprovals for hospital stays, certain treatments, or needed medical equipment. Most Advantage Plans are regional, so policyholders can only receive covered care in their immediate area.

To explore your Medicare Advantage Plan options, contact Medicare Planning of Dayton. Since 2006, they have served the Miami Valley and Southwest Ohio, offering assistance with all aspects of Medicare and long-term care planning. They will ensure you find the best policy for your needs, budget, and future. Call (937) 504-9999 or visit them online to schedule a Medicare consultation.