Were you aware that Original Medicare (Parts A and B) doesn’t cover all of your doctor and hospital expenses? The services it doesn’t cover – known as coverage gaps – can become very expensive over time if you don’t protect yourself with a Medicare supplemental insurance plan. Thankfully, there are a variety of such plans which exist for you to choose from. One such plan is called Medicare Advantage (Medicare Part C). It effectively replaces your current federal Medicare benefits with private health insurance coverage designed to mimic what you would normally get from Original Medicare.
Federal Regulations for Medicare Advantage
To ensure that you receive the federal Medicare benefits which you are entitled to as a retired US citizen, federal laws closely regulate Medicare Advantage policies. At the very least, your Advantage policy will include the same coverage and benefits as Medicare Parts A & B. It will also likely include additional benefits to protect against coverage gaps. Furthermore, many plans include Part D prescription drug coverage, among other ancillary benefits.
Medicare Advantage Enrollment In Kentucky
When it comes to Kentucky seniors, 28% have chosen to allow a private healthcare insurance company to manage their Medicare benefits. What are the other 72% doing? Well, we can only imagine that the majority of them are choosing to stick with the federal government in order to receive and manage their Medicare benefits. They may also be working with a private health insurance plan from a previous employer.
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
The fact that you live in Kentucky, as opposed to somewhere like Delaware, will significantly influence how much you pay for your monthly premium. If you are older, and/or enrolled in Medicare after you turned 65, it might make your plan more expensive. To get an idea of what you might be expected to pay, take a look at the estimates below:
Most Popular Medicare Advantage Plans in Kentucky
When you’re shopping around for a Medicare Advantage plan, how do you know if the company you’re looking at will be good for you? How do you know they will be prompt, courteous, and responsible with your claims? How do you know anything about their financial stability, or whether they are competent when it comes to care management? You’ll know with our five star rating system, that’s how. The more stars a company earns, the more value you can expect to get from any Medicare Advantage plan they sell you.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
For some seniors, you may be required to switch doctors or hospitals in order to receive care within your provider network. HMO networks are more restrictive with fewer options, while PPO and PFFS networks are more inclusive. Additionally, your provider has the ability to change who is and is not included within your provider network at any time. So be prepared to deal with these unexpected changes before you officially sign up for a policy.
Where you generally need to get your care and services from for:
- HMO Plans – It can be tricky to get the care you want if you are limited to a Health Management Organization plan. These networks tend to be more limited than others, and you’ll end up paying exorbitant out-of-pocket costs from out-of-network providers – unless you are forced to get care at an out-of-network facility due to a medical emergency. Some HMO Networks offer POS (Point-of-Service) flexibility if you have very specific, specialized needs which you cannot get from an in-network doctor or facility.
- PPO Plans – PPO stands for “Preferred Provider Organization”. On these plans, virtually no doctor or facility is off-limits for you. However, there are a limited amount of preferred providers which your health insurance company would prefer you to patronize. In almost any situation, your insurance will still cover you and your claim will be honored; the only difference is that your medical costs will be substantially less from a preferred provider.
- PFFS Plans – A Private Fee-For-Service plan is a little bit more complicated than an HMO or a PPO Network. Instead of automatically accepting Medicare like most doctors and facilities do, the practitioners who provide you with care negotiate on a case-by-case basis with your insurance company. You may not always get the care you need, even if you’ve been there before for similar services. It’s important to call ahead and check in advance to make sure they’re still accepting your insurance before you are surprised with a catastrophic medical bill.
- Special Needs Plans – SNPs and HMOs have a lot in common. They both have more restrictive networks than their PPO or PFFS counterparts. It can also be much more expensive to get care outside of your network unless you require immediate medical attention. But the Special Needs Plans can be very cost-effective for people with special medical needs, like end-stage renal disease or other necessary end-of-life care. Special Needs Plans also provide leeway if you need to get specialized medical care outside of your network for an affordable cost.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans – With any HMO plan, seniors who require immediate medical attention won’t have to waste time worrying about whether the emergency room they go to is within their provider network. But you will have to consult with your plan benefits and potentially a representative from your insurance company if you want to make sure the rest of the medical care you receive is in-network. Otherwise, it can get very expensive very quickly.
- PPO plans – With PPO plans, you will have much less to worry about when it comes to finding affordable care. This is especially true with Medicare Advantage. You should try and stick with your list of preferred providers if you want to keep your costs as low as possible. But the vast majority of doctors and hospitals are still available to you at some sort of discount.
- PFFS Plans – PFFS plans hinge on whether or not the care provider you seek will agree to your insurance plan payment terms before they treat you. This is much more common with providers who are in-network, but you’ll have to do a lot of work to find a PFFS doctor or facility out-of-network who will agree to the payment terms of your plan, even with Medicare Advantage.
- Special Needs Plans – There are only two exceptions to getting out-of-network care on a special needs plan: if you need to go to the emergency room, or if you need highly specialized care from a physician or facility which is out of network, and nobody within your network can provide that same care. SNPs are usually reserved for seniors who have specialized medical needs and who will require specialized medical care from very specific practitioners.
Drug, Vision and Dental Coverage
While the provider network system might seem like too much of a hassle, the comprehensive coverage provides a positive trade-off for some seniors. Most other supplement insurance policies require you to purchase ancillary coverage, Such as Part D or vision benefits, separately. But you can put all of those and more onto the same Medicare Advantage plan. This puts all of your coverage under one, single, streamlined plan. Just remember that the more coverage you add, the more you will have to pay each month.
- If you want vision coverage along with your Medicare benefits, then this is one area where Medicare Advantage can give you just that: an advantage. Lots of Medicare Advantage providers will sell you additional vision coverage, albeit at a higher cost. You may have restricted networks with your vision care, too, so be sure to discuss those details with your insurance agent.
- Taking care of your teeth and gums is important at any age. Despite this fact, your government Medicare benefits won’t offer you affordable dental options unless you go private or unless you go with Medicare Advantage. Again, purchasing extra dental coverage may increase your monthly premium. You’ll also want to double-check and make sure you are going to in-network dentists and offices for the most affordable price.
Enrollment Options & Best Time To Enroll
Unlike other supplements, it can be trickier to get covered under a Medicare Advantage plan. Because your provider is a private insurance company, they have the right to gather information about your current health status and evaluate whether or not they can afford to insure you if you are applying outside the recommended Open Enrollment window and have a pre-existing condition. The closer you are to age 65, the easier it will be to avoid rejection. But if you have ESRD (End Stage Renal Disease) or other serious medical conditions, you may be denied. For more information, you can consult your state department of insurance, or visit our Medicare Advantage Enrollment Options page.
- Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
- Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.
What Medicare Advantage Plan Is Best For Me?
In a lot of ways, even the most prepared and well-informed seniors will be flying blind when it comes to choosing a Medicare Advantage program. Comprehensive ratings and reviews from sites like ours will help you choose a good company. Accurately anticipating your future medical needs can help you choose the right plan. But there are many other unpredictable variables at play which can throw everything off kilter if you aren’t careful.
Unfortunately, you don’t have a generous amount of time to make such important decisions. The Medicare enrollment period is very limited and a little difficult to pinpoint. On top of that, assuming you are unsatisfied with the plan you get and you want to change, your evaluation period is very short. If you stick with organizations like ours, we can help you sort through the confusion and get a satisfying plan from a solid company for a fair price. But you have to act fast, or you’ll miss out on your opportunity.