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Sound Advice: November 10, 2021

Medicare 301

Beyond the basics of Medicare Parts A, B, and D lies Medicare Advantage, an all-in-one plan that includes the major parts of Medicare as well as coverage for additional services.  The additional services covered include vision, hearing, and dental.  What’s more, these plans may have lower out-of-pocket costs. 

Currently, more than 40% of Medicare beneficiaries are enrolled in Medicare Advantage plans.  That percentage is increasing.  Most of these plans are provided by UnitedHealthCare, Humana or BlueCross BlueShield.

Medicare Advantage plans come in several varieties, though most are Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).  HMOs are usually the least costly and require that participants receive services from assigned providers.  What’s more, certain requirements must be met in case of emergencies before the plan will pay for services provided.

PPO participants are free to use the services of any provider in their network.  The additional flexibility of PPO plans is a key reason for their greater popularity. 

Not surprisingly, there are significant drawbacks to Medicare Advantage plans.  Unlike original Medicare, which allows you to go to any doctor or hospital in the U.S. that accepts Medicare, participants in Medicare Advantage plans are required to use the doctors in their plan’s network.  Plus, unlike original Medicare, if you need to see a specialist, a referral may be required.  That can become a big problem if the network does not have the providers needed.

Medicare Advantage plans may be desirable for those living in urban areas, but in rural areas where there are few hospitals and doctors, original Medicare is often seen as a better choice. 

Medicare Advantage participants who go to a hospital or see a doctor outside the network may have to pay the full cost.  For those with serious health issues, it will be helpful to remember that there is a broad range of capabilities within the ranks of those who have earned medical degrees.  When selecting a provider, remember that there is a critical difference between the best the individual can do and the best that can be done.

N. Russell Wayne, CFP®

Sound Asset Management Inc.

Weston, CT  06883

203-222-9370 

www.soundasset.com

www.soundasset.blogspot.com

Any questions?  Please contact me at nrwayne@soundasset.com

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