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Medicare Advantage Plans Part 2: More About Pricing

In the first part of this two part series, we discussed the general concept of Medicare Advantage plans in Kansas City or anywhere in the US. Now we will take a closer look at the costs involved and how it will affect your budget. The monthly premium for these plans are most likely combined with the Part B premium in order to establish one payment. Due to the fact that these plans have different terms, amounts for out-of-pocket expenses vary.

The cost of these expenses are the results of the following:

1. If the Part B monthly premium covered by the plan.

2. The associated cost per visit or service.

3. If there is an additional or annual deductible included with the plan.

4. The limits for out-of-pocket costs that are annual.

5. If extra benefits are needed for which the plan covers.

6. If the plan requires a monthly premium.

7. How often health services are utilized along with the type.

7. If all rules are followed by the network providers in regards to the plan.

8. Coverages

These types of plans usually cover urgent care and emergency services. They are not supplemental. All services that Medicare supplemental health insurance covers, must be covered. There is one exception. Hospice services are covered by Original Medicare no matter if that person has the Medicare Advantage Plan. Not only do these plans cover prescription drugs, but they also include different health and wellness programs. Common programs such as dental, hearing, and vision are covered as well.

Things To Consider With Advantage Plans

Three things need to be considered in regards to these types of plans. First of all, changes have been made recently, so things may not be the same. Coverages of the plan are started once the enrollment form is received. This starts on the first day of the following month. During this time, stay away from the following:

1. Deciding to change from Original Medicare to an Advantage Plan.

2. Deciding to change from one Medicare Prescription insurance coverage plan to another.

3. Dropping, switching, or joining a Medicare Medical Savings Account Plan.

4. Changing from one Advantage plan to another.

Members will continue to have the same protections with the Medicare Advantage Plan, as they did with the Original Medicare. This includes being able to appeal. Make sure to check the plan before obtaining services. Ask about the cost associated with the service as well as coverages. However, make sure that rules of the plan are followed. For instance, if a referral is needed for a specialist, then get one. If certain procedures require certain approval, then obtain it. Higher costs result when rules aren’t followed.

For those with pre-existing conditions, it is still okay to sign up with a Medicare Advantage Plan. Those that are in the final stage of renal disease, unfortunately, aren’t able to do so. Enrollment is available only during designated times throughout the year. Usually, people are enrolled in a plan for a year. Most of the time, if any service is performed by a practitioner at an unapproved facilities, the service won’t be covered. Sometimes a small amount may be covered, but charges are higher. Original medicare has to be used if Medicare involvement is dropped by the plan. Individuals may also need to find another health plan.

Enrollment Procedures

Due to the fact that all these Medicare Advantage plans are different, comparisons need to be made in regards to Medicare health plans within the area. Before joining, pay close attention to costs and plan rules. Information about the quality of certain plans for comparison purposes, is offered by Medicare.
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