Medicare Advantage Plans provide coverage to individuals who would not be able to afford traditional Medicare if they continued coverage through the traditional health care system. Advantage Plans are offered by selected Medicare-approved private companies.
Coverage is essentially the same as traditional Part A hospitalization, Part B health insurance, and, in most cases, Part D prescription drugs coverage. However, there are differences in each member’s Medicare Advantage Plan, including eligibility, cost, types of providers covered, provider payment rates, and more.
Private companies that offer Medicare Advantage Plans can be classified into two broad categories: HMOs and PPOs. A PPO is a fee-for-service plan that allows patients to choose their own health care provider. Medicare Part A and Part D Medicare prescription drug coverage are excluded from PPOs. Some PPO plans also allow pharmacies to participate in the program, thereby providing medications to patients free of charge. HMOs, on the other hand, are fee-for-service plans that require patients to use a specific healthcare provider.
Members of best Medicare supplement plans 2022 may also have access to supplementary services, or additional benefits not available to them through regular Medicare. These additional benefits may include extended hospital stays, specialized medical care, home health care assistance, hospice care, hearing aids, emergency travel protection benefits, prescription drugs, vision care, physical therapy, hospice, and psychotherapy. All members of Medicare Advantage Plans are required to pay a portion of these benefits, known as “out of pocket expenses.”
Most of the time, providers of Medicare Advantage Plans share the costs with hospitals and providers of Medicare Parts A and B. Even when a Medicare Advantage Plan member has a high-deductible health plan, he or she may still have to pay part of the expenses for some kinds of healthcare services.
There are several upcoming changes for 2021 due to covid-19. One of these is that non-network providers will no longer be able to provide some Medicare Advantage Plans’ out-of-network benefits. According to a Centers for Medicare and Medicaid Services (CMS), this change takes effect on “practically all” Part A and B drugs.
This includes “listing drugs that are not covered by the Medicare Part D drug plan,” which includes both durable and long-term care drugs. The purpose behind this new rule is to prevent “fiscal hardship,” according to CMS. Other Part A drugs that are currently out-of-network will continue to be available to all patients, but will be limited in what pharmacies they can be purchased from.
Another upcoming change for 2021 is that Medicare Advantage plans will no longer cover out-of-network providers for certain medications. Specifically, medications used to treat Medicare patients with end-stage renal disease will no longer be covered by these plans’ providers.
End stage renal disease is one of the most serious medical conditions in the country. According to CMS, the decision was made “to provide more efficient care for Medicare beneficiaries.” The majority of patients with this condition do not have Medicare Advantage plans, which means they would have to pay the full price for prescription drugs like these out of pocket.