⦁ With Medicare Advantage (Part C), you can access a wide range of medical services and specialized care by bundling multiple services into one plan.
⦁ Special Needs Plans (SNPs) offer customized care and support for individuals with specific health conditions or living situations.
⦁ These plans cover emergency and urgent care within the U.S. and internationally to support medical expenses even while traveling.
Healthcare can be unpredictable, as unexpected medical expenses can strain even the most carefully planned family budgets. Senior family members with Medicare may find it challenging to bear medical management and emergency care costs. However, Medicare Advantage can offer flexibility and resources to families seeking comprehensive healthcare.
Why Original Medicare May Not Be Enough?
Basic Medicare offers a strong foundation for healthcare coverage, but it may not fully meet the diverse needs of all individuals. Because it is limited in covering certain prescription drugs, preventative care, and other healthcare services, you will have to spend more out-of-pocket costs during medical emergencies.
Lack of Healthcare Service Options
Basic Medicare is designed for essential coverage but often lacks the comprehensive services available through other options. It includes Part A (hospital insurance) and Part B (medical insurance) but leaves out some necessary benefits for your family, such as screenings for vision, dental, hearing, and prescription drug coverage (Part D).
This limitation means you must seek supplemental policies for additional services, potentially leading to higher medical costs and confusion when managing multiple providers.
Lack of Personalized Care
Basic medicare plans don’t include partner hospital networks like health maintenance organizations (HMOs) or preferred provider organizations (PPOs). As a result, they can lack the personalized care that comes from working with a coordinated network of doctors, hospitals, and specialists.
For families with seniors managing multiple chronic conditions, this can mean less streamlined care and a higher risk of receiving unnecessary or duplicated tests and services. It can also make it harder to receive treatments that are coordinated and tailored to individual healthcare needs.
Lack of Specialized Programs
Without options such as special needs plans (SNPs), basic medicare policies do not provide targeted care for specific groups, such as people living in nursing homes (I-SNPs) or individuals eligible for both Medicare and Medicaid (D-SNPs). Also, chronic special needs plans (C-SNPs) cannot be availed of for those in your family with severe or disabling chronic conditions.
Why Medicare Advantage is a Smart Choice for Your Family?
With over 54% of American beneficiaries enrolled in 2024, Medicare Advantage is quickly becoming the preferred choice for families. This plan offers a comprehensive and flexible solution for seniors seeking an alternative to original Medicare.
Wellness and Preventive Care Benefits
Advantage plans can be modified to give you and your family the option to have a wider selection of healthcare facilities. This includes drugs and supplementary care benefits like regular checkups, screenings for serious issues like cardiovascular diseases and diabetes, and age-appropriate immunizations. Some plans cover about 100% of the cost spent, which can help you take proactive measures to diagnose and treat illness.
Emergency and Urgent Care Coverage
Advantage coverage provides emergency and urgent care coverage, both within the U.S. and internationally. If a family member falls ill or needs urgent care while away from home, they can rest assured that their Medicare Advantage plan will cover the medical expenses. This can also be claimed in case of necessary medical attention while traveling, along with transportation services in case of medical emergency.
In-Home Support Services
While original Medicare plans cover home health care, they may not provide sufficient coverage for long-term care or services such as nursing. In addition, non-skilled care such as personal hygiene, medical management, mobility assistance for daily activities, etc., may not be available. Your family members can also enjoy post-surgical care, reducing expensive hospital readmissions. Though it can vary, you can get services specific to your local region for better physical care.
Along with other essential education to support the person who needs the most care, you can also access respite care through the caregiver support programs in the plan.
Over-the-counter (OTC) Allowances
You can use your over-the-counter (OTC) allowance benefit to purchase eligible non-prescription health and wellness items. This coverage offers a monthly or quarterly allowance and can cover a wide range of products like vitamins, pain relievers, dental care items, and other first-aid supplies. These allowances can be used at approved retailers or online, offering convenience and savings for everyday health needs.
Out-of-Network Coverage Flexibility
Medicare Advantage plans can allow beneficiaries to receive care from providers who are not part of their plan’s network, though often at a higher cost. Insurance providers can help you modify your coverage to provide some degree of coverage for out-of-network care. This gives the freedom to seek treatment from a broader range of healthcare professionals. Its important to note that the cost of out-of-network care can vary depending on the plan.
How to Enroll in Medicare Advantage?
You or your loved one will have to be enrolled in Medicare Part A and Part B, and either 65 years and above to be enrolled in Medicare Advantage. Also, if an individual is under 65 but with a disability, they are eligible for Part C.
The Initial Enrollment Period (IEP) starts three months before an individual turns 65—this includes the birthday month—and ends three months after. The Annual Enrollment Period (AEP) occurs typically from October 15 to December 7 each year. If you are looking for an Open Enrollment Period (OEP), the first quarter of the year might be useful, where you can also make changes to your current plan. While it is a coverage that can support your family, it is also necessary that you compare the plans and choose what suits the best for your needs.
With so many options available, it’s important to partner with someone who understands the nuances and complexities of the plans. At HealthMarkets Insurance – Eric Zawicki, you can get expert advice to help you navigate the options that are best for you and your family. Reach out today to receive the healthcare insurance that your family deserves!
