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Medicare Part A covers the cost of hospital visits and has a deductible. In 2020, that deductible is $1,408. Medicare Part B covers 80% of the cost of outpatient services, including doctor’s visits, and more. Part B has a deductible of $198 in 2020. Therefore, Medicare does not cover all a person’s medical expenses. Medical expenses can change over time, and depending on your healthcare needs, can require a lot of upfront money out-of-pocket. This is where Medicare Advantage supplemental benefits come in handy.
What is Medicare Advantage?
Medicare Advantage is a health insurance plan that people can purchase from a private insurer that offers coverage for things that Original Medicare does not cover. These expenses might include vision, dental, and fitness programs such as gym memberships.
Medicare Advantage plans can differ based on the insurer, the state, and the person’s needs. Medicare Advantage, often referred to as Part C or MA Plans, still allow a person to have Medicare Parts A&B through the Medicare Advantage plan. People’s out-of-pocket costs are often lower in a Medicare Advantage Plan than in an Original Medicare plan.
Because Medicare Advantage plans cover some services not included in Original Medicare, people with Medicare Advantage may not purchase Medigap.
Who Qualifies for Medicare Advantage
To understand who qualifies for Medicare Advantage, it is vital first to understand who can qualify for Original Medicare. To qualify for Original Medicare, a person must be an American Citizen or permanent legal resident for at least five years in a row. Additionally, they must be 65 years or older or eligible for Medicare due to a disability.
In addition to meeting the qualifications for Original Medicare, a person must be either be eligible for or enrolled in Medicare Part A and Part B. Then, they must live within their Medicare Advantage plan’s service area. Service areas can vary by county.
Some people may not be able to qualify for Medicare Advantage plans. If someone has an end-stage renal disease (ESRD) or permanent kidney failure, you will likely not qualify for any Medicare Advantage plans. Even if you have ERSD or another disease that you believe may disqualify you from Medicare Advantage plans, you can contact the plan you hope to enroll in as the rules change often.
Additionally, there are Medicare Advantage plans called Special Needs Plans (SNP). There are a few types of SNPs, and some include people with ERSD. Depending on your location, you may qualify for Medicare Advantage, even with a significant disability.
What are Medicare Advantage Supplemental Benefits?
A supplemental benefit is something Medicare Advantage offers that is not available through Original Medicare. Each plan has different rules for where the supplemental benefits can be used, so be sure to check with your plan before visiting a doctor or healthcare provider.
Some of the benefits included in some MA plans are dental care, vision care, hearing aids, and gym memberships. When choosing a plan, be sure to research what is covered by Medicare to ensure that the services being promised to you are not already covered. Additionally, make sure that your service providers are in your plan’s network so that you can take advantage of the benefits you are paying for.
Supplemental Benefits for Chronic Conditions
If you are chronically ill, you may be able to qualify for Medicare Advantage benefits. To be considered chronically ill, a plan will determine that you have at least one medically complex condition that is life-threatening. Your insurer may also require that your condition significantly limit your health or function and that you have a high risk of hospitalization or other adverse health outcomes. Additionally, it may require that your condition requires intensive care coordination when you fall ill.
It is important to remember that not every plan will benefit people with specific chronic illnesses, including ERSD. For example, some plans might not cover people with severe asthma.
What to Consider When Buying a Medicare Advantage Plan
Medicare Advantage plans can differ between insurers. Therefore, it is important first to understand your needs. You may want to consider your budget for a Medicare Advantage plan, the other coverage you have, and what coverage you feel you need. You may also want to inquire with your insurer to see if your potential plan covers your doctor or local hospital.
Once you know what your needs are, you can begin shopping around for a Medicare Advantage plan. You may want to start on the Medicare.gov website to see what plans are available.
Alternative Options
If you realize that Medicare Advantage is not for you as you do your research, there are other alternatives available.
Medigap Plans
Medigap plans fill the coverage gaps that Original Medicare does not cover. There are several types of Medigap plans. Plans A, B, C, D, F, G, K, L, M, and N each have different coverage sets and range in price depending on where you live and what they cover. Medigap may cover copayments, coinsurance, and deductibles that Medicare does not cover. The private insurance company will receive the bill for work done.
Medicaid
Medicaid is a program that helps with the medical costs for people with limited income and resources. It also offers benefits not offered by Medicare, including long-term care and in-home care services. To be eligible for Medicaid, a person must prove financial eligibility and that they are residents of the state they are applying in. Medicaid covers services including inpatient and outpatient hospital services, laboratory, and x-ray services, and more.
Reduced-Cost or Free Clinics
If a person can’t afford medical coverage or needs a service not provided by their healthcare coverage, they may choose to seek out reduced-cost or free clinics. These are clinics that base their pricing on a sliding scale depending on a person’s income. This helps to make healthcare available to low-income individuals.
Donated Dental Service Programs or Dental Schools
Like finding a reduced-cost or free clinic, some schools offer discounted services to the public. These schools include dental schools, chiropractic colleges, and more. If you need dental work done, it is often possible to get it done for free or at a steep discount at a local dental school. Be sure to search for your local dental school or dental service program and call ahead to make an appointment.
The Takeaway
Medicare Advantage supplemental benefits offer a variety of benefits that Medicare Parts A & B do not. In addition to offering Original Medicare coverage, some supplemental benefits are available to people with chronic illnesses. For individuals who can’t afford supplemental coverage, additional options exist, including Medicaid and the access to free and reduced-cost clinics nationwide.
As you decide how to implement your retirement healthcare strategy, be sure to speak with a financial advisor. They can help point you in the right direction of plans and providers that fit your needs.
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