Choosing a Medicare Advantage plan implies you have to have sound knowledge and awareness about the cost-sharing details. The plans of MA are not similar to the Original Medicare. In fact, it may include additional rules, so before enrolling, you may consider each plan. To begin with the details:
- Part B Medicare premium: This generally as per Medicare Advantage plans is expected to be paid as premium. There may be additional premiums also charged in this plan and in some, they may pay for the Part B premium as part payments.
- Deductibles: The Medicare Advantage plans actually charge for their services a deductible and this includes outpatient, inpatient and prescription drug. The deductibles vary with each plan.
- Copayments: The plans of MA charge copay for the visits of doctor instead of coinsurance 20% that you usually pay with Traditional Medicare. So, bear in mind that the plans of MA cannot charge you more copays that the Traditional Medicare especially for certain care such as skilled nursing facility, dialysis and chemotherapy care.
- Out of pocket Maximum limit: The plans in MA include a limit as maximum for out of pocket expenses. It means the amount you pay from your pocket is capped yearly and this safeguards you from spending in excess even if you need more care or services. These limits are high and they cover deductibles and copays. Apart from this, bear in mind that the coverage rules are different with each MA plan.
The Medicare Advantage plans cover services on receiving from hospitals, doctors and pharmacies only when it is as per their plans network. Thus, before enrolling into any of the plans, ensure your providers or doctors are also a part of the network list and they are ready to accept the plans new patients. Remember, hospitals and doctors may at any time leave the plan, but at the same time you cannot do so. You have the option to leave the Medicare Advantage plans only in the enrolment period. This is the right time so that you do not incur a penalty.
The Medicare Advantage plans mostly offer the same cover of the Original Medicare. They will expect you to pay for few services. For instance, there are plans that require permission from the provider to offer the services or some plans need formal referral if you wish to see a specialist.
Note: Buying a Medigap policy as an MA Plan supplement for cost-sharing cover is not possible as Medigap policies work only in association with Original Medicare.