When you’re approaching retirement and considering your health insurance needs, Original Medicare (which provides Parts A for hospitalization and Part B for doctor’s appointments and other care) may not seem to offer everything you need.
Medicare Advantage Plans can help replace that limited coverage and offer a more customizable level of support.
Since nearly 37% of the 62.5 million people who enrolled in Medicare in 2019 use Medicare Advantage, it’s critical to understand what it is and how it works to avoid wasting money.
Let’s break down some of the most common myths associated with this health care program to bring some clarity before you start shopping for health insurance this year.
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Medicare Advantage and supplemental plans are the same
One of the most common misunderstandings is the difference between Medicare Advantage and Medicare supplemental plans, known as Medigap.
Medicare Advantage plans replace Original Medicare (Parts A and B). You get a different policy altogether.
Medicare supplemental plans supplement Original Medicare, giving you more coverage than what Parts A and B offer, such as adding Part D for prescription drug coverage.
You often need either an Advantage plan or Original Medicare with supplemental coverage.
Medicare Advantage is the best option for chronic health issues
If you’re suffering from heart disease, have had cancer, or have Type 2 diabetes, Medicare Advantage plans can be the ideal choice, but only if you choose a plan provider that offers flexible, comprehensive coverage.
Original Medicare, by contrast, allows you to use any provider that accepts Medicare, which may mean having more options when you need a specialist. With Medicare Advantage, you may need a referral to see a specialist.
If you purchase a Medicare Advantage plan, you still need drug coverage
Medicare Advantage plans typically allow you to obtain a policy that includes all the care you need, including Part A, Part B, and Part D coverage for prescription drugs.
With an Advantage plan, you don’t need to purchase Part D separately if you’ve selected a plan that includes it.
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Medicare Advantage doesn’t cover hearing and vision
It’s true that Original Medicare doesn't include hearing, dental, and vision care, but Medicare Advantage may.
You often may pay a fraction of the cost you were paying prior to Medicare with a Medicare Advantage plan.
When you switch to Medicare Advantage, you lose Medicare
It’s a misconception that moving to Medicare Advantage means you no longer have Medicare coverage. You don’t have Original Medicare, but you still receive Medicare coverage in a different form.
You’ll now receive Medicare through a private health insurance company outside the federal government.
The Medicare Advantage deductible is higher
With Medicare Advantage, you select the type and level of coverage you need, and the good news is that your deductible isn't typically more than what you would pay for Original Medicare.
If you have just Original Medicare, chances are good your deductible will be higher, especially when you add the cost of Medigap and prescription drug coverage deductibles. Medicare Advantage deductibles tend to be lower.
Medicare Advantage's out-of-pocket maximum is too high
Another common financial misconception is that the out-of-pocket maximum you will pay is higher with Medicare Advantage, but that’s not true.
Original Medicare has no maximum, and unless you have Medigap, you can expect to continue paying those out-of-pocket costs.
However, Medicare Advantage plans typically have a top-out amount of $8,300 for in-network care and $12,450 for in- and out-of-network care when you receive both.
You can only choose from a small group of health insurance providers
Medicare Advantage is a private insurance policy, meaning you're likely to have a network of providers you need to see.
However, the pool is not necessarily small; remember, you can pick and choose which private service you use.
Also, the standards for provider networks are set by the government. In nearly all situations, you have numerous professionals for most needs.
You can't join Medicare Advantage with a pre-existing health condition
You can shop for Medicare Advantage plans with a pre-existing health condition and are unlikely to be denied coverage for it.
As with all insurance plans, consider the specific care specialists you need and want to see since some restrictions may apply.
Once you leave Original Medicare, you can't go back
Each year, you can make adjustments to your health insurance coverage. That could include switching to and from Original Medicare.
If you move to a Medicare Advantage plan and find that it’s not working for you, you can switch to another one or return to Original Medicare during the open enrollment period each year.
Original Medicare is free
Some people believe Original Medicare is free, which makes it seem like moving to an Advantage plan wouldn’t make sense. But Original Medicare is not free.
With Original Medicare, you pay for insurance through a monthly premium (deducted from your Social Security payment if you receive benefits).
You must also meet your deductibles and pay coinsurance coverage out-of-pocket, as well as Part D and, in some cases, Medigap coverage.
Original Medicare covers everything you need
Original Medicare has two components. Part A covers most of your costs related to inpatient medical care when you're in the hospital. Part B covers some preventive health care costs, like routine lab work and seeing your doctor.
Original Medicare doesn’t cover hearing, dental, or vision. It doesn’t provide coverage for fitness programs or care for holistic services.
Original Medicare also doesn’t typically cover transportation to and from the doctor’s office, though some Medicare Advantage plans may.
You can't get Medicare Advantage plans if you're under 65
Medicare services become available to people when they reach 65 or if they become disabled and unable to work.
If you have an injury that qualifies for Social Security Disability Insurance, you may be able to tap into Medicare Advantage plans earlier than age 65.
Original Medicare will assist living or nursing home care
Original Medicare has some coverage for nursing homes for a limited amount of time each year and with numerous restrictions. However, some Medicare Advantage plans could provide more coverage for these needs.
Remember that long-term care insurance is a separate insurance product you may purchase to help defray the cost of long-term care if needed.
Everyone pays the same thing for Medicare
What you pay for Medicare differs from what others pay based on your work history. Medicare Advantage plans also vary in cost based on factors like which policy you select.
Don’t assume that you're paying the same amount your neighbor pays. Instead, request a quote to ensure you get quality coverage.
Choosing the best Medicare coverage for you is key, which means researching. Don’t assume that Original Medicare is the best.
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