It may not seem important now, but purchasing Medicare supplement insurance can save you thousands in unforeseen medical expenses over time. One form of Medicare supplement insurance which is available to Medicare-qualified seniors is Medicare Advantage, also known as Medicare Part C. This private health insurance policy replaces your federal Medicare benefits and sometimes comes with restrictive provider networks, but gives you the option to add additional coverage benefits beyond what might be available to you with Medicare alone, or with Medicare + Medicare supplement insurance.
Federal Regulations for Medicare Advantage
To protect seniors from purchasing inferior coverage, Medicare Advantage policies are regulated by the federal government. Thanks to these regulations, it is illegal for any insurance provider to sell you coverage which is less than what you would get from Original Medicare (Parts A & B). Most policies, though, come with not just Original Medicare benefits, but also enough coverage to protect you from costly coverage gaps.
Medicare Advantage Enrollment In Louisiana
33% of Louisiana seniors have elected to go with a Medicare Advantage program in order to utilize their Medicare benefits. The other two-thirds (66%) of seniors in the state are probably sticking with Original Medicare. A minority of those may be using an old employer’s retirement health plan, however.
|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
Several different personal factors will influence how much you might pay for your policy. For example, a male smoker who waited until the age of 70 to enroll in Medicare will likely pay a higher rate than most seniors. The chart below lists estimated costs for Medicare Advantage plans near you:
Most Popular Medicare Advantage Plans in Louisiana
As you saw earlier, there are different types of Medicare Advantage plans for sale. For the most part, these plans are distinguished by what sort of provider network you will be included in. The more restrictive the network, the fewer doctors and facilities you will be able to visit – but keep in mind that such plans are often more affordable than the less restrictive ones.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Make sure you get plenty of information on your Medicare Advantage plan’s network restrictions before you sign on the dotted line. The various types of networks – which include HMOs, PPOs, and PFFS networks – all have different rules on which doctors you can see, and how you can get access to medical care outside of your preferred network. You should be prepared in case you happen to fall ill while on vacation, or if one of your preferred doctors leaves your chosen network.
Where you generally need to get your care and services from for:
- HMO Plans – Do you want to keep your monthly premiums low? Then you’ll likely end up with a Health Management Organization plan. These networks are a bit limited, so if your aim is to keep your costs down you’ll want to be pretty strict about staying in your network. But don’t worry; there is an exception for emergency care in extreme cases. Furthermore, if your HMO has a point of service (POS) exception, you may be able to go out of network for specialized care whether or not it’s an emergency.
- PPO Plans – These plans may be a little pricier, but it may be worth the money for some seniors. Preferred Provider Organization networks allow you access to any doctor or facility who accepts Medicare. But they don’t allow you access to the same value. Out-of-network providers will cost more, no matter what. They incentivize you to stay in that work with attractive discounts.
- PFFS Plans – Private Fee-For-Service plans can offer you a wider choice of doctors compared to more restrictive HMO Networks, but only on a case-by-case basis. Not every single provider will accept your plan based on the fact that it is Medicare alone. They will also have to negotiate with your insurance provider and agree to their payment terms. If they cannot agree, they will not treat you.
- Special Needs Plans – If you have special medical needs – especially as they relate to chronic disease or end-of-life care – then you may be getting treatment through an SNP Network. Keep in mind that these are very similar to HMOs and that you can only really get medical care outside your network if it is a medical emergency. If you want to get medical care outside your network, especially care which is relevant to your special medical needs, you will have to negotiate with your insurance company.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans – When you need Medical Care on an HMO plan, you first need to choose a primary care doctor and then only go to the experts they refer you to. Going out of network or going against the wishes of your primary care physician can be very expensive, with the exception of emergency medical care.
- PPO plans – PPO Medicare Advantage plans are the most like a government -managed Medicare Plan. You can basically see any doctor, facility, or hospital you want as long as they take Medicare. The only difference is that you’ll probably have to pay a little bit more for out-of-network Medicare facilities than you would going to a Medicare friendly doctor or hospital which is also in your PPO Network.
- PFFS Plans – Private Fee-For-Service plans seem a little bit more open for some seniors as opposed to others. In certain areas they may have the flexibility of a PPO plan, but your insurance company will still have to negotiate with your chosen care provider to make sure everyone agrees to the payment terms. Otherwise, you’ll have to find a different doctor or facility from which to get your care.
- Special Needs Plans – SNPs tend to be almost as restrictive as HMO plans, given the fact that you can’t usually get care outside of your approved network. There are obvious exceptions for emergency care, but also a few more. You may be able to get non-emergency care out of your network if it has to do with the special medical needs (such as ESRD) that made you eligible for the SNP in the first place.
For your convenience, Medicare.gov has an easy and efficient database you can search to see if your preferred doctor(s) and facilities are included in your plan.
Drug, Vision and Dental Coverage
One thing that balances out the difficulty of provider networks is the fact that you can get a streamlined and comprehensive level of coverage which most other Medicare supplement insurance does not provide. MAPD plans offer you the ability to add prescription drug coverage to your policy. You also have the option of including dental care, or vision. But the more you add, the more expensive your plan will become. Keep these facts in mind when deciding on a policy.
- Medicare Advantage is one of those health insurance plans which has a bit more customization than others. Each plant starts with the same basic benefits that Medicare Part A and B offer, and offer extras such as vision coverage. Keep in mind that this extra coverage will likely cost you more and isn’t necessarily available in all areas. It’s best to consult the terms of your plan or an insurance agent so that you know if there are restrictions on what type of eye doctor you can visit.
- You may also be eligible to purchase dental coverage with Medicare Advantage. But, like vision coverage, you might want to check with your provider to see if there are limited dental networks where you can get your care from. You should also be prepared to pay a little bit more for dental care seeing as how it is an optional addition to any Medicare Advantage plan.
Enrollment Options & Best Time To Enroll
Because Medicare Advantage policies are provided by private companies, it can be more difficult to be approved for a plan. Your provider has the ability to request information about your health, and also pre-existing conditions, before they approve your policy. Those at the highest risk for rejection are seniors with serious conditions such as ESRD (End Stage Renal Disease. For more information on getting covered with a serious health condition, contact your state department of insurance. You can also visit our Medicare Advantage Enrollment Page.
- Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
- 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): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.
What Medicare Advantage Plan Is Best For Me?
There are a lot of things to consider when you are getting ready to purchase a Medicare Advantage plan. You need to find the most affordable policy you can, but within reason. Obviously you also want a financially stable company who will handle your care confidently, efficiently, and compassionately. Your plan must also be capable of meeting not just your current but your future medical needs.
On top of how complicated that task can be, the fact that you are working with in a very limited Medicare enrollment period window is even more challenging. But with our help, we can steer you in the right direction towards an affordable plan which meets your needs and is provided by a responsible company. We can also help you evaluate new plans if the one you’re currently on is not up to your standards. Just contact us today and we’ll be happy to answer any questions you may have.