Medicare Advantage plans (MAPD) have exploded in popularity since re-introduced around a decade ago. Is it the best plan for you? What makes these plans so popular?
It’s no secret prescription drug costs are rising much faster than inflation, and overall health spending is up. Every year, it seems the government raises the Medicare Part B premium, Medicare Supplement (Medigap) and Medicare Part D (PDP) plans cost more, too. Although I assume by now you already know what a Medicare Advantage plan is (click here if you don’t for a primer) there are very distinct reasons why according to Kaiser Family Foundation 31% of all seniors are now enrolled in a Medicare Advantage plan.
Medicare Advantage plans come in 3 flavors.
- PPO – “Preferred Provider Organization” – you can use doctors and hospitals in and out of the plan’s network.
- HMO – “Health Maintenance Organization” – you cannot use doctors out of the plan’s network
- HMO-POS – “Health Maintenance Organization – Point of Service” – while rare, these plans let you go out of the plan’s network, often requiring a referral from a doctor who is in the network.
So, why choose a Medicare Advantage Plan?
Combined Medical and Drug Coverage
Remember the acronym in the first sentence? Medicare Advantage is the same thing as an “MAPD.” That stands for Medicare Advantage Prescription Drug. By far the biggest reason people enroll in these plans is because they get their medical coverage and their prescription drug coverage all in one plan, with one company. It doesn’t matter if you’re at the pharmacy, in your doctors office or at the hospital; one card in your wallet is all you need.
Premiums Are Inexpensive (or $0!)
The number of plans available to you varies depending on where you live. Cities get more choices, rural areas only a few. Generally, the availability of these plans increase where there are more people in a geographic area who have Medicare. For most of you, there are usually multiple insurance companies in your area offering $0 premium MAPD HMO plans. They can afford to not charge you a premium, because they’re getting reimbursed from the government for your care and prescription drugs. You can usually find HMO plans with better benefits for an additional premium ranging between $19-$40 per month. PPO plans are available too, although typically there are fewer options and they’re more expensive at $30-$150 per month, depending on the plan.
Limit Out-of-Pocket Costs
Original Medicare Part A and Part B have significant drawbacks to them, and never cap the amount of money you can potentially spend should you get really sick. Click here for a post I wrote a while back on this subject. MAPD plans have a feature called the MOOP. MOOP stands for Maximum Out Of Pocket. Medicare mandates MAPD plans pay 100% of your medical care after a maximum of $6,700 out of your pocket in a calendar year. Many plans have a lower MOOP and this is a KEY factor you should be shopping for, by the way. The lower the MOOP, the better for you.
Low Co-pays for Doctor Visits and Prescriptions
Medicare Advantage insurance companies want you to see your primary care physician, and as soon as possible. While that might not make much sense on the surface, it does if you have a medical condition. If you have a medical condition and the doctor notes it in his or her chart, the insurance company can file for additional reimbursement from the government for your care. Good for them. All this really means to you is your doctor copays on a Medicare Advantage are low (usually $5-20 per visit, sometimes $0!). Insurance companies also want to make sure you’re taking your prescriptions. That’s right! If you don’t, they get dinged in the wallet by the government in a variety of ways. That’s why prescription drug copays are generally less expensive on MAPD plans than they are on Medicare Part D (PDP) plans.
Extra Benefits Not Offered by Medicare
The government allows Medicare Advantage plans to offer some bells and whistles to their plans to sweeten the deal for potential buyers. Many, but not all plans offer built-in dental coverage, vision insurance, hearing aid coverage and even an over-the-counter purchasing allowance. You get none of those items I just mentioned on Original Medicare, Part D or a Medicare Supplement plan. If you were actually able to find a dental plan to purchase outside of an MAPD plan, I’d a) be amazed and B) tell you not to buy it because it’s not worth the money. More on that in another post.
There you have it. Four pretty good reasons to elect a MAPD plan for your Medicare coverage… low (or no) premiums, a limit on your yearly financial exposure, low co-pays for doctors and prescriptions and some dental, vision and other “freebies” thrown in for good measure.