Do the gaps in Medicare Parts A and B have you worried about out-of-pocket medical expenses down the road? Well, you don’t need to worry, because there are easily affordable Medicare supplement insurance policies out there which can protect you. The trick is to find the one which gives you the coverage you need for the right price. One solution you might be considering is a Medicare Advantage (or “Medicare replacement”) plan. We’ll explain Advantage plans in detail, as well as give you all of the advantages and disadvantages of such a policy.
Federal Regulations for Medicare Advantage
The reason that Advantage plans are sometimes referred to as “Medicare replacement” is because, essentially, that is what they do. With Medicare Advantage, you are purchasing a private health insurance policy from a private company which provides exactly the same or better coverage than Traditional Medicare. That company then becomes responsible for paying out your Medicare-related health claims. The government no longer covers you.
Medicare Advantage Enrollment In South Carolina
Medicare Advantage is fairly popular in South Carolina, but not overly so. Around 24% of Medicare-qualified seniors have signed up for Medicare Advantage. Of course, there are many different types of Advantage plans available for purchase. Some of them are more popular than others, as the chart below explains:
|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
In this section, you can get a look at estimated rates for Advantage policies available near you. Keep in mind, however, that these are estimates. You will need to talk to a local insurance agent near you for accurate quotes, which are based on your own personal circumstances.
Most Popular Medicare Advantage Plans in South Carolina
You may be wondering how we rate our Medicare Advantage plans. We’ve developed a sophisticated system which gives eats plan an overall star rating. Our system evaluates the quality and performance of each plan and assigns it a maximum of five stars, with five stars being the best score you can get. We take things like screenings, tests, chronic condition management, and overall customer satisfaction into account when we evaluate a plan and assign it an overall star rating.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Your provider network will play an important part in your decision to obtain an Advantage plan, as well as which plan is right for you. Some networks are more exclusive than others, significantly limiting the doctors and facilities where you can get medical care. Other networks are larger with fewer restrictions – sadly, they are also more expensive. Additionally, the doctors and hospitals which are part of your network can change at any time, forcing you to switch doctors without much warning.
- HMO Plans – An HMO plan is also known as a Health Management Organization plan. These plans center your medical care around your primary care doctor and only allow you to get care from approved medical professionals/facilities in your network. You usually require a referral from your primary care doctor before you can get care somewhere or from someone else in-network. If you have an emergency, your insurance will cover any out-of-network care you have to receive. Other than that, getting out of network care will likely cost you full price out of pocket.
- PPO Plans – Preferred Provider Organization plans give you a little more freedom then HMO networks do. You can see any doctor or visit any medical facility you’d like for care – but you won’t have to pay as much for care if you stick with in-network doctors and facilities. But these plans do tend to have higher premiums and other associated costs, so keep that in mind while you’re shopping around.
- PFFS Plans – Private Fee-For-Service plans are very similar to Indemnity plans in the Private health insurance industry. You can get care from any doctor or facility you wish, and your care will be covered by your insurance company as long as your care provider agrees to their payment terms. But not all doctors or facilities will. To make things even more complicated, the doctor or facility where you get your medical care can change their mind at any time and decide not to cover you for future appointments. It’s important to keep in touch with any doctors, hospitals, or outpatient facilities that you frequently get care from to make sure they’re still on board.
- Special Needs Plans – Special Needs Plans are typically reserved for those who have substantial medical needs, like people with end stage renal disease (ESRD). Like an HMO plan, SNPs have exceptions when it comes to getting emergency care outside of your limited network. Other than that, you will have to get permission from your insurance provider if you feel you need specialty care which is not available in-network.
- HMO Plans – Medicare Advantage HMO plans work exactly how you would expect them to based on how the private networks work. You choose a primary care doctor, they give you referrals for any other medical care you may need, and you pay your monthly premium as well as any agreed-upon shared costs between you and your medicare advantage insurance provider. You will also get the same exceptions with regard to emergency care and out-of-network doctors/facilities.
- PPO Plans – Preferred Provider Organization plans work no differently under Medicare Advantage than they would any other type of insurance plan. You have the freedom to see any doctor or get care from any facility you wish, although out-of-network doctors and facilities will still cost you a little more.
- PFFS Plans – A Private Fee-For-Service plan, even when it is part of a Medicare Advantage plan, will still let you get care from any doctor, hospital, or outpatient facility you wish as long as the caregivers agree to the payment terms of your Medicare Advantage provider. The likelihood that they will change their mind at any time is the same, so you will have to keep in touch with them and double-check before every single appointment – unless you’re okay with paying full price, that is.
- Special Needs Plans – Special Needs plans under Medicare Advantage may actually be a little cheaper than they would be if it was just a private health insurance plan. You might also have better access to the doctors, facilities, and hospitals you need given that Medicare networks tend to be larger than private health insurance Networks. Like an HMO, you will still report to a primary care doctor and get referrals from them for the extra care you need. You will also get exceptions for emergency care that you receive from an out-of-network doctor, hospital, or facility.
If you’re concerned about whether or not your doctor will be part of your Medicare Advantage health insurance network, medicare has you covered. Take a look at their handy search tool and give them just a few bits of basic information (like your location, and your doctor’s name) to find out if the medical network your Medicare Advantage plan provides is right for you.
Drug, Vision and Dental Coverage
When it comes to vision coverage, this benefit is unique to Medicare Advantage plans. Original Medicare and other supplements like Medigap insurance do not provide vision coverage. If you decide not to go with a Medicare Advantage plan, you might be able to find private vision insurance from a local provider at a decent price. Or you could enroll in a Medicare Advantage plan and choose to have it added to your benefits for a relatively affordable cost.
It’s important to keep your teeth and gums healthy as you get older. Unfortunately, dental coverage is it provided for and either Original Medicare or Medigap supplemental insurance. Some Medicare Advantage plans, though, will give you the option to add it in with your other benefits. Then all you have to do is choose your primary care dentist and pay for any shared costs according to the benefits of your dental plan.
Enrollment Options & Best Time To Enroll
The best time to enroll is during your Early Enrollment Period, within your first six months of turning 65. However, you can enroll later with little hassle if you happen to qualify for a Special Enrollment Period. If you wait to enroll, or if you are trying to get covered with a pre-existing medical condition such as End Stage Renal Disease, getting approved will be much more challenging. However, you have options. Your state department of insurance will have more information on getting covered with a pre-existing condition, as well as your local insurance agent. You may also want to take a look at our Medicare Advantage Enrollment Options page.
- Initial Enrollment Period: For best results, try to enroll in a Medicare Advantage plan within your first 6 months of Medicare enrollment.
- Annual Enrollment Period (AEP): You have the option of changing or cancelling your Medicare Advantage and Part D drug plan between October 15th and December 7th every year.
- Special Enrollment Period (SEP): If you lose your employer plan coverage, move out of your coverage area, or lose coverage from your provider, you could qualify for an SEP.
What Medicare Advantage Plan Is Best For Me?
If you choose to go with Medicare Advantage, keep in mind that you and your insurance provider are going to be together for the long haul. Switching plans in the future may be difficult, so make sure you do your research and look into the company’s financial stability, reputation, and check out their customer service reviews before making a decision. Your anticipated future medical needs and costs should also be taken into consideration before you choose a provider.
Once you have a good idea of what you need and the type of company you want to get it from, you can start shopping around. It’s the only way to get the most affordable coverage from a trusted provider. But you’ll need to hurry, because open enrollment periods are fairly narrow. Contact us for more information if you’re worried about missing your open enrollment or if you’re still having trouble trying to decide on a provider. We’d love to hear from you.