Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you are enrolled in a Medicare Advantage Plan, your Medicare services are covered through that plan, and are not paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
How do Medicare Advantage Plans Work?
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare, however your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage come from the Medicare Advantage Plan and not Original Medicare.
Covered Services in Medicare Advantage Plans
Medicare Advantage Plans cover all Medicare services. Most Medicare Advantage Plans also offer extra coverage, such as vision, hearing, and dental coverage.
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
Each Medicare Advantage Plan can charge different out-of-pocket costs and can also have different rules for how you get services. These rules can change each year and may include:
- Whether you need a referral to see a specialist
- Whether you are enrolled in a plan which requires you to use a network of doctors, facilities, or suppliers for non-emergency/non-urgent care.
What do Medicare Advantage Plans Cost?
Your out-of-pocket costs in a Medicare Advantage Plan depend on:
- Monthly premiums charged by the plan
- Yearly or additional deductibles
- Co-payment or co-insurance you are required to pay
- The plan may charge a co-payment every time you see a doctor
- These amounts can be different than those under Original Medicare
- The type of health care services you need and how often you get them
- Whether or not the doctor or supplier accept assignment (if you are in a PPO, PFFS, or MSA plan and you go out-of-network)
- Do you follow plan rules, such as using network providers?
- Do you need extra optional supplement benefits? Does the plan charge you for them besides your monthly plan premium?
- Yearly limit on your out-of-pocket costs for all medical services
- Do you have Medicaid or get help from your state?
Each year plans establish the amount charged for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. The plan benefits may change only once a year, on January 1.
If you’re in a Medicare plan, review the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) your plan sends out each fall.
A Medicare Supplement Insurance (Medigap) policy is sold by a private company, and can help pay certain health care costs that Original Medicare does not cover (co-payments, co-insurance, and deductibles).
Some Medigap policies also offer coverage for services not included in Original Medicare, such as medical care when traveling outside the United States. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs, and your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage Plans are ways to get Medicare benefits, while a Medigap policy only supplements your existing Original Medicare benefits.
Hospital Indemnity Plans
Hospital indemnity plans provide completely separate benefits from your main medical insurance plan, regardless of the actual cost of the service. When covered medical expenses resulting from hospitalization, surgery, chemotherapy and radiation services build up, your Hospital Indemnity Plan (HIP) will pay a fixed amount. That amount may be per day, per week, per month, per visit or per event, depending on the plan and the benefit that applies. HIP policies are standalone, which means they do not coordinate with your other health insurance coverage.
The options and benefits available to you will vary by plan. Some HIP cover additional services such as ambulance trips, second surgical opinions, and even chemotherapy and radiation. Optional health maintenance and diagnostic testing benefits that pay a fixed amount for preventive care, X-rays, urgent care and other services may also be available with some plans.
Final Expense Plans
Final expense insurance is a type of life insurance designed to cover the costs of an individual’s “final expenses,” such as funeral services, loans, legacy planning needs, and other outstanding bills.
There are 2 main types of coverage an individual can qualify for based on a short health interview.
This is the type of coverage that will pay the full life insurance benefit starting immediately upon approval.
“Graded benefit” means there were some concerns with the health interview over pre-existing conditions, and that the life insurance benefit will pay out on a reduced basis the first 2 years. For example, if you have a $10,000 final expense policy approved, many companies will pay out 30% of the 10,000 if you die in year one, 70% in year two and 100% in year three. Different companies have different payout schedules, so it’s important to fully understand before making any purchase decisions.
Both types of plans listed above offer up to $25,000 in final expense coverage. Some final expense companies have age restrictions that would reduce the total amount you can apply for. For example, many companies will not allow graded benefits to exceed $15,000 for applicants over the age of 70. So, it’s important to have detailed discussions with your final expense agent or final expense company representative.
The average cost of a final expense policy depending on your age is around $40-$50 per month for roughly $10,000-$12,000 in coverage. Due to the low monthly premiums, some people often refer to final expense as “affordable end-of-life insurance”.
Life Insurance Plans
Life insurance is a contract to provide a measure of financial security for your family after you die. The three main components of the life insurance contract are a death benefit, a premium payment and, in the case of permanent life insurance, a cash value account. You pay now so after your death, your dependents can continue with their lives comfortably without the burden of the loss of household income. When purchasing a life insurance policy, consider your financial situation and the standard of living you want to maintain for your dependents or survivors.
For example, who will be responsible for your funeral costs and final medical bills? Would your family have to relocate? Will there be adequate funds for future or ongoing expenses such as daycare, mortgage payments and college? It is prudent to re-evaluate your life insurance policies annually or when you experience a major life event like marriage, divorce, the birth or adoption of a child, or purchase of a major item such as a house or business.
Cancer Indemnity Plans
Cancer Insurance is an insurance policy that pays only after cancer is diagnosed. Cancer insurance is supplemental insurance, and most types pay policyholders a lump sum upon diagnosis with a covered cancer, while others offer supplemental payments for healthcare costs.
Many cancer insurance policies provide a one-time payment, up to the policy limits, upon cancer diagnosis. Typically, this money can be used for whatever the policyholder chooses, whether for travel expenses (such as for traveling to a specialist or cancer center), co-payments, experimental treatments, or living expenses.
Supplemental Payments for Healthcare:
These payments follow a schedule listed with the policy, rather than paying in one go. It does not pay a percent of your bill; it pays a certain dollar amount for each covered category such as radiation treatment, x-rays, surgery, or hospice care. The expenses paid by a cancer insurance policy depend on the terms of the policy, which should be reviewed carefully before purchasing a policy.