The Benefits of a Medicare Advantage Plan
By Ally Ruiz Balcerzak
Each year, the annual Medicare open enrollment period runs from October 15 through December 7. Much like the open enrollment window for employer-sponsored health insurance, the Medicare window is when Americans ages 65 and up can change their coverage by signing up for Original Medicare (Parts A and B), enrolling in a Medicare Advantage Plan (Part C), or signing up for prescription drug coverage (Part D).
In 1965, Title XIX of the Social Security Act established the Medicare program to provide health coverage for older Americans due to the lack of options available to them after retirement. Original Medicare was split into two parts — hospital insurance under Part A, and medical insurance under Part B — and went largely unchanged for decades. However, in 2003, the Medicare Prescription Drug Improvement and Modernization Act gave participants more options and control over their coverage with the creation of Part C: privately run Medicare Advantage Plans, and Part D: enhanced prescription drug coverage.
The Benefits of a Part C Plan. One of the main benefits of a Medicare Advantage Plan is the consolidation of Parts A, B, and D coverage under a single plan — much like the employer-based and marketplace coverage we’re already used to. With a Medicare Advantage Plan, you go to a single website or call one phone number any time you have questions about your coverage or healthcare costs.
Compared to Original Medicare, Medicare Advantage plans typically also cover extra days in the hospital, offer supplemental dental care options, and have an out-of-pocket maximum that caps the amount of money you’re required to spend on healthcare in a given year. If you have a chronic illness, or are diagnosed with something that requires expensive treatment, the out-of-pocket max can save you hundreds — or thousands — of dollars in the long run.
To enhance the value of Medicare Advantage Plans, many insurers also include perks such as gym memberships, health and wellness programs, and out-of-area coverage. Since each plan comes with different member perks, you can choose which benefit enhancements are important to you as a way to help keep your monthly premium costs down.
Choosing a Medicare Advantage Plan. All of the major health insurers in Western New York offer Medicare Advantage Plans, so when it comes to choosing a Plan, you have options. One thing to consider at the start of your research is whether an HMO or PPO plan is right for you. With an HMO plan, you’ll need to see in-network providers in order to avoid paying for services out-of-pocket, but as a trade-off will typically pay lower premiums. On the other hand, PPO plans allow you see out-of-network providers for a higher cost (that’s lower than paying out-of-pocket), making these plans ideal for travelers or those who spend part of the year outside of Western New York.
For additional information on Medicare and your coverage options, go to medicare.gov.
Ally is a writer and marketing consultant in Buffalo, NY. She works with small and new businesses to manage their online presence, create shareable content, and develop operational processes that scale. Her work and contact info can be found at ruzedigital.com.
