Let’s face it, healthcare is a confusing alphabet soup of acronyms. You have MCR for Medicare, MCD for Medicaid and those are just the household names. When you get to Medicare Part A, Part B, and Part D that’s when things get really confusing. One of the less known plans that has been getting a lot of media coverage as well as attention in the healthcare world is Medicare Advantage. So what is Medicare Advantage? How is it different than regular Medicare? What does it cover? Why is it getting all of this attention all of the sudden? And is it right for you?
Let’s start with the basics. What is Medicare? Medicare is an insurance plan that is offered through the United States Government. Someone is eligible for Medicare if they are 65 or older, if they are younger but have certain disabilities, or have End-Stage Renal Disease; permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD. In a different post we will discuss the variation between Medicare parts A, B, and D but for today just know that there are subsections in the world of Medicare. This is where Medicare Advantage differs. With the Medicare Advantage, these three parts are bundled into one convenient plan. Where with regular Medicare you would need to select a carrier for each section, here it is all sourced from one company. That leads to the question: What are some of the practical differences?
There are actually several. One difference is you need to make sure that the doctors, or in the event necessary, your hospital, is in-network with the Medicare Advantage plan you would consider. Conversely that under straight Medicare you can go to any doctor or hospital in the U.S. that is a Medicare provider. Another difference is cost. Plans have a different fee structure than straight Medicare which might affect your out of pocket costs, deductibles, and yearly premiums. Another difference is coverage. Traditional Medicare covers most medically necessary services and supplies in hospitals, doctor’s offices, and other healthcare settings while Medicare Advantage covers all of those and offers extra benefits. Some of these benefits are transportation to health-related services, such as the doctor’s office or pharmacy, emergency care coverage outside the country, over-the counter medications, adult day-care services, and lastly personal care services such as help with housekeeping, dressing, and home delivery meal services. This last benefit is a real game changer for the Baby Boomer population that wants to age in place and is looking to avoid going into a long-term care or skilled nursing facility. Coverage and availability will change from plan to plan but just having the benefit be added to the list of covered services is a tremendous benefit.
In summation, Medicare Advantage is certainly a popular product and it will in all likelihood gain more membership as the benefits expand. As to whether or not Medicare Advantage is right for you, it is best to discuss it with a loved one or confidant to help weigh the pros and cons. What’s good for the goose isn’t always good for the gander.