Exploring Medicare Advantage in My Area: Uncover the Benefits

Are you ready to unlock the potential benefits of Medicare Advantage in your area? Look no further. This informative article will explore the advantages of Medicare Advantage plans and how they can enhance your healthcare coverage.

Medicare Advantage, also known as Medicare Part C, goes beyond what Original Medicare provides. With a Medicare Advantage plan, you can enjoy additional benefits like prescription drug coverage, dental care, and vision services in one convenient package. But that’s not all – some plans even offer fitness memberships, transportation services, and telehealth options.

By delving into the specifics of Medicare Advantage, we’ll help you understand how these plans work, what they cover, and whether they align with your unique healthcare needs. We’ll also examine how you can find the right plan for you in your local area.

Don’t settle for one-size-fits-all healthcare coverage. Discover the customized benefits and added features that Medicare Advantage plans can offer. Read on to learn more about the advantages waiting for you right around the corner.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan offered by private insurance companies that contract with Medicare. These plans provide an alternative way to receive your Medicare benefits, combining the coverage of Parts A (hospital insurance) and B (medical insurance) and often including additional benefits not covered by Original Medicare.

One key characteristic of Medicare Advantage plans is that they are required to provide at least the same level of coverage as Original Medicare. However, many plans go above and beyond. They put a cap on spending. Original Medicare is unlimited. There are small copays for services. Original Medicare Part B is an unlimited 20%. Part D prescription drug plans are usually included. With Original Medicare, you must purchase a separate Part D plan. Many Medicare Advantage plans have no deductible for the prescription side of the plan in the Omaha, Lincoln, & Council Bluffs areas. Most of the Part D plans have a large deductible. The most common deductible for 2024 is $545. Medicare Advantage offers additional benefits such as dental care, vision services, and hearing aids. That would be a separate policy and monthly premium on Original Medicare.  

In summary, Medicare Advantage plans offer a comprehensive and convenient way to receive your Medicare benefits, often with added benefits not available through Original Medicare alone.

Medicare Advantage Enrollment & Eligibility

Now that we’ve explored the benefits of Medicare Advantage let’s discuss how you can enroll in a plan and determine your eligibility.

To be eligible for Medicare Advantage, you must meet the following criteria:

• You must be enrolled in both Medicare Part A and Part B. You still must continue to pay your Medicare Part B premium.  
• You must live in the service area of the Medicare Advantage plan you wish to enroll in. If you leave that area, you will be disenrolled. You will then need to enroll in another plan in your new area in a timely manner.  

Once you meet these eligibility requirements, you can enroll in a Medicare Advantage plan during specific enrollment periods. 

• Initial Enrollment Period (IEP) occurs when you first become eligible for Medicare, typically three months before your 65th birthday, the month of your 65th birthday, and three months afterward.  
• Annual Enrollment Period (AEP) takes place from October 15th to December 7th each year, during which you can switch or enroll in a Medicare Advantage plan.
• Special Election Periods (SEP) occur for special circumstances. For example, you move out of the service area. Another common SEP is when you lose employer health coverage. There are many others.    

It’s important to note that Medicare Advantage plans may have different networks of doctors and healthcare providers, so it’s essential to confirm that your preferred healthcare providers are included in the plan’s network before enrolling. Each area has its unique circumstances.

Medicare Advantage in the Omaha, Lincoln, & Council Bluffs areas is exceptionally good when it comes to networks. There are four provider networks: CHI (Catholic Health Initiative), Methodist Health Systems, Nebraska Medicine (UNMC), and Bryan Health. All of these networks work with the six insurance companies with Medicare Advantage contacts in the area.  

Original Medicare vs. Medicare Advantage

Original Medicare is only Part A for hospital and Part B for doctor visits and outpatient services. Part A currently has a deductible of $1,632 for an event in 60 days. Part B is a 20% coinsurance that is unlimited.  

Medicare Advantage covers the same as Part A & Part B, but there is a maximum out-of-pocket (MOOP). The MOOP is potentially $8,850 in-network and $13,300 out-of-network. These amounts are the maximum cap a plan can have. All Medicare Advantage plans MOOPs in Omaha, Lincoln, and Council Bluffs are much lower.  The most popular plan MOOP is $3,800. 

Medicare Advantage plans have small copays for various services. For example, doctor visits maybe 0-$10, emergency rooms $120-$135, and outpatient surgeries $250-$350. All of the copays go against the maximum out-of-pocket (MOOP).  

How to choose the Right Medicare Advantage Plan for You

With numerous Medicare Advantage plans available, choosing the right one that meets your healthcare needs is crucial. Here are some factors to consider when selecting a Medicare Advantage plan:

Medications Covered

Run your medications through the various software available, including the Plan Finder on the Medicare.gov website. Make sure your medications are on the formulary. Look for the plans with the lowest total copays for your medications.  

Provider Network

Medicare Advantage is managed care, so there are networks, versus Original Medicare, which is fee-for-service (FFS). Check to make sure your doctors and hospitals are in the plan network.  

We are fortunate to have strong network affiliations with the Medicare Advantage plans in Omaha, Lincoln, and Council Bluffs. There are four networks: CHI, Nebraska Medicine, Methodist Health Systems, and Bryan Hospital. All six Medicare Advantage companies in our area work with these networks. However, we still check to confirm providers are in the network.  

Maximum Out-of-Pocket in Budget

The maximum out-of-pocket is the most you must pay in a calendar year. Does that amount work in your budget? A Medicare Supplement coupled with Original will cost approximately $2,000-$3,000 per year, depending upon your age and location. You will pay the monthly Medicare Supplement premium regardless of any medical expenses. With an Advantage plan, you only pay copays if you see a doctor or have something done medically.   

HMO vs. PPO

Medicare Advantage plans that are Health Maintenance Organizations (HMO) will only pay for services provided in the plan’s network. That is the limitation. When traveling, you are covered anywhere for an emergency.  

Medicare Advantage plans that are Preferred Provider Organizations (PPO) cover services in and out of the network. Out-of-network care providers who accept Medicare but are not in the local service area network are covered. Those providers may charge more, and the maximum out-of-pocket expenses are usually larger.  

PPO plans are best for people living in multiple locations or with limited local network coverage. Again, a PPO Medicare Advantage Plan has no real advantage in the Omaha, Lincoln, and Council Bluffs areas because all providers are in the four local networks.  

Many insurance companies with Medicare Advantage contracts also have national networks. That means you can access doctors and hospitals in other parts of the country far from home, still be in the network, and pay in-network copays. It is always important to confirm a provider’s status before seeking treatment. I have had a number of clients leave the Omaha area and go to facilities in other states while on their HMO Medicare Advantage plan and pay in-network copays.  

Copays

To explore the Medicare Advantage plans available in your area, you can use the Medicare Plan Finder tool on the official Medicare website (medicare.gov). This tool allows you to enter your zip code and compare the different plans offered in your local area.

The Medicare Advantage comparison tool is helpful when looking at copays. There are many plans, and copays differ from plan to plan and service to service. If you are looking through company sales brochures, you will become cross-eyed. A comparison tool, either at Medicare.gov or through an insurance agent you are working with, will make the review process much more manageable.  

Over the years, I have listened to many clients voice their opinions on which copays are more important than others. I try to make clients aware of essential copays and the differences between the plans. They come to their own conclusions and rankings for the plans based on what they see.   

Additional Benefits

The big attraction of Medicare Advantage is the additional benefits. It is interesting to listen to clients’ comments and compare the additional benefits between plans. Those who don’t wear glasses pass over that benefit, and those who have issues with their teeth will laser focus on the size of the dental benefit and the network.  

Over-the-counter (OTC) benefits are getting a second glance this year because some companies reduced their amount, and another company kept it comparatively large. When the plans are very similar in terms of all other benefits, one benefit, like OTC, can make the deciding difference.  

Once you have covered these essential aspects of the plans in your area, you should have a feeling about which plan (or plans) best address your needs. Going through this checklist will narrow your selection to a plan or couple of plans that will serve you best.  

Exploring Medicare Advantage Plans in Your Area

Some large metro areas have many, many plans. In the Omaha area, we have six insurance companies that offer 27 Medicare Advantage plans in the Nebraska counties of Douglas, Sarpy, Washington, Cass, Saunders, and Lancaster, and five insurance companies offer 26 plans in Pottawatomie County in Iowa.  

So there is an excellent variety. The complaint I hear quite often is that there are too many choices. The large number of plans and the different copay amounts and benefits are overwhelming and make the selection process confusing for many of my clients.  

If an independent agent lives and works in the area, he should be able to compare and explain most plans. One of the problems I have with agents out of call centers in Florida, California, or the Philippines is that they do not know the local area and the plans because they don’t live here. They are unaware of the subtle differences between the companies and plans. The telesale agent has no lived experience or history with the Medicare Advantage plans in Omaha, Lincoln, and Council Bluffs.  

Their primary concern is to switch you into the plan they are selling so they get paid. If there are problems later, they will not be there to answer your calls. They may not even be in the business after Open Enrollment.      

Bottom Line: Is Medicare Advantage Right for You?

Medicare Advantage plans offer a wealth of benefits and added features that can enhance your healthcare coverage. From additional benefits like prescription drug coverage and dental care to added perks like fitness memberships and telehealth options, Medicare Advantage plans provide a comprehensive and convenient way to receive your Medicare benefits.

When considering Medicare Advantage, it’s important to carefully compare the plans available, review their coverage and benefits, and consider your specific healthcare needs. Doing so lets you choose the right Medicare Advantage plan that aligns with your preferences and provides the coverage you require.

Unlock the potential benefits of Medicare Advantage in your area. With over two decades of experience at Omaha Insurance Solutions, we know the Medicare Advantage plans well in Nebraska & Iowa. We can guide you through the selection process. 

With the right plan, you can enjoy comprehensive benefits, cost savings, and a more convenient healthcare experience. Take control of your healthcare today and call us at 402-614-3389 to speak with an insurance agent professional to explore the possibilities of Medicare Advantage.