“For most people, the biggest single benefit of Medicare Advantage is the out-of-pocket maximum,” says Diane Daniels, a Medicare consultant and author of Medicare Nation. Original Medicare doesn’t have an out-of-pocket maximum, which means there is limit to the out-of-pocket expenses a member could pay within a year. Since Original Medicare pays about 80 percent, and the member is responsible for the other 20 percent, that remaining amount can really add up. With Medicare Advantage, you’ll know what your yearly out-of-pocket max is and can budget accordingly.
“People also choose Medicare Advantage because of its extended hospital coverage,” Daniels says. Typically, these plans eliminate the Part A deductible for hospitalization, $1,364, and they may offer lower copays than Original Medicare for hospital stays and many other services.
Robert J. Jackson, M.D., a family care physician in Allen Park, Mich., says his patients on Medicare Advantage like the extra benefits, such as vision, hearing and dental coverage. Some group insurance plans lack these benefits, but they only grow in importance as people age.
Jackson is also a fan of SilverSneakers®, a program that offers access to thousands of fitness centers and helps enrollees devise a plan to lose or maintain weight. SilverSneakers is offered with all of Blue Cross Blue Shield of Michigan’s Medicare Advantage plans. “That’s a great benefit,” he says.
Keep it in the network
Like many employer-sponsored plans, Medicare Advantage plans are HMOs or PPOs. HMO plans control costs by encouraging members to seek care within a network of doctors and hospitals. Blue Cross’ Medicare Advantage PPO plans give members access to tens of thousands of leading doctors and hospitals coast to coast. Members pay in network rates with providers that accept both Medicare and the Blue Cross card.
When it comes to emergency and urgent care, you’re always covered with a Medicare Advantage plan. Blue Cross also covers medical emergencies abroad.
Some final things you should know
With Medicare Advantage, you can change your plan, without the need for a medical exam, during the annual enrollment period, if your health care needs or finances change.
The monthly cost of a Medicare Advantage premium will depend on factors, including the benefits offered, the size of the network, and the deductible and out-of-pocket maximum. The premium also depends on your ZIP code, because different plans are offered in different areas. And since Medicare plans cover individuals, you and your spouse can have different plans depending on your specific health care needs.
If you have Original Medicare (Parts A and B) and want to learn more about your costs under a Medicare Advantage plan, you can call a Blue Cross Blue Shield of Michigan and Blue Care Network-contracted agent, at 1-888-563-3307, 8 a.m. to 9 p.m. Monday through Friday. TTY users should call 711. You can find available plans online.