As your 65th birthday approaches, or if you're already enrolled in Medicare, your Initial Coverage Election Period (ICEP) or the next Annual Election Period (AEP) are essential times for you. Everyone has opinions about Medicare and what coverage is best. Advice from friends, family, and neighbors is great, but the choice is based on you and your needs when it comes to health care. Here are ten common myths about Medicare Advantage that we'd like to debunk (or at least dig a little deeper).
Myth #1: If you join a Medicare Advantage plan, you no longer have Medicare
Medicare Advantage is also known as Part C and is just another way to get Medicare coverage. You receive your Part A, and Part B benefits from a private health insurance company instead of the federal government, and you also receive additional supplemental benefits.
Myth #2: Medicare Advantage Plans and Medicare Supplement Plans (MedSupp, Medigap) are the same
These are two different types of plans, and you cannot have Medicare Advantage and MedSupp at the same time. Medigap plans fill the gaps in coverage in Original Medicare. They generally have higher monthly premiums than HMO or HMO-POS Medicare Advantage plans, but you can see any doctor who accepts Medicare. With a Medigap plan, you will have to buy a separate prescription drug plan (Part D) if you want prescription drug coverage. We explained this in more detail in a previous blog article.
Myth #3: Medicare Advantage plans are too expensive
With Original Medicare (Parts A and B), some copays, deductibles, outpatient doctor visits, and outpatient doctor services aren't covered. There is also no out-of-pocket maximum. To fill the coverage gap, Medicare beneficiaries look to purchase supplemental insurance coverage (Medigap) or enroll in a Medicare Advantage plan. Several types of Medicare Advantage plans are available, with different premiums, copays, and deductibles. The plans also have an annual limit on out-of-pocket costs for health care for enrollees. Once that limit is reached, you pay nothing for covered services.
Myth #4: Medicare Advantage plans force you to see a small group of providers
The federal government sets the rules for provider networks. While Medicare Advantage HMO and HMO-POS plans have a panel of providers that you can choose from and are expected to use, in most cases, it's about coordinating and personalizing your care. More than 700 doctors, many other health care providers, and all four hospitals in Monterey County are part of the Aspire Health Plan network.
Myth #5: Medicare Advantage plans are only for seniors in excellent health
Original Medicare can't deny you because of a pre-existing disease or condition. Medicare Advantage plans cannot deny coverage based on health status. Medicare Advantage plans also offer care coordination and disease management, which can help those living with chronic conditions. Also, beginning in 2021, all eligible beneficiaries with End-Stage Renal Disease (ESRD) can now enroll in a Medicare Advantage plan.
Myth #6: All Medicare Advantage plans are the same
The most critical differences between Medicare Advantage plans are provider networks, prescription drug coverage, and premiums (and the extra benefits included in the schedule). Plan sponsors like Aspire Health Plan also offer different plan options to meet your needs better. If you're interested in joining a Medicare Advantage plan, you'll need to make some plan comparisons to determine which method best fits your needs and preferences.
Myth #7: Medicare Advantage plans can make changes to your health coverage without telling you
Each year, before the start of Open Enrollment (October 15 – December 7), Medicare Advantage plans contact enrollees to notify them of changes to their Medicare Advantage plan through the Notice of Annual Change (ANOC) detailing changes in the plan's benefits for the following year.
Myth #8: When choosing a Medicare Advantage plan with Part D (MAPD) coverage, drug lists, and drug costs aren't readily available
Most Medicare Advantage plans offer Part D coverage in a combined policy known as an MAPD plan. When looking for an MAPD plan, you can use the Medicare Plan Finder Tool or contact a specific plan to find out if the prescription drugs you need are included in the drug list they offer. There is also an Extra Help program to help you pay for drug program costs, like premiums, deductibles, and coinsurance.
Myth #9: Medicare Advantage plans don't offer dental, vision, or hearing coverage
Original Medicare does not offer vision, hearing, or dental benefits. Most Medicare Advantage plans offer these benefits. Plus, Medicare Advantage plans can now add extra benefits not included in regular Medicare, like transportation, chiropractic, acupuncture, and fitness options.
Myth #10: Once you join a Medicare Advantage plan, you can't change your coverage
You can change plans during the Annual Election Period (AEP) or return to Original Medicare each year. You may also qualify for a Special Enrollment Period (SEP) if you move into, leave, or reside in a skilled nursing facility (SNF) or long-term care (LTC) hospital or if you move out of an area geographic.
10 Myths About Medicare Advantage
As your 65th birthday approaches, or if you're already enrolled in Medicare, your Initial Coverage Election Period (ICEP) or the next Annual Election Period (AEP) are essential times for you. Everyone has opinions about Medicare and what coverage is best. Advice from friends, family, and neighbors is great, but the choice is based on you and your needs when it comes to health care. Here are ten common myths about Medicare Advantage that we'd like to debunk (or at least dig a little deeper).
Myth #1: If you join a Medicare Advantage plan, you no longer have Medicare
Medicare Advantage is also known as Part C and is just another way to get Medicare coverage. You receive your Part A, and Part B benefits from a private health insurance company instead of the federal government, and you also receive additional supplemental benefits.
Myth #2: Medicare Advantage Plans and Medicare Supplement Plans (MedSupp, Medigap) are the same
These are two different types of plans, and you cannot have Medicare Advantage and MedSupp at the same time. Medigap plans fill the gaps in coverage in Original Medicare. They generally have higher monthly premiums than HMO or HMO-POS Medicare Advantage plans, but you can see any doctor who accepts Medicare. With a Medigap plan, you will have to buy a separate prescription drug plan (Part D) if you want prescription drug coverage. We explained this in more detail in a previous blog article.
Myth #3: Medicare Advantage plans are too expensive
With Original Medicare (Parts A and B), some copays, deductibles, outpatient doctor visits, and outpatient doctor services aren't covered. There is also no out-of-pocket maximum. To fill the coverage gap, Medicare beneficiaries look to purchase supplemental insurance coverage (Medigap) or enroll in a Medicare Advantage plan. Several types of Medicare Advantage plans are available, with different premiums, copays, and deductibles. The plans also have an annual limit on out-of-pocket costs for health care for enrollees. Once that limit is reached, you pay nothing for covered services.
Myth #4: Medicare Advantage plans force you to see a small group of providers
The federal government sets the rules for provider networks. While Medicare Advantage HMO and HMO-POS plans have a panel of providers that you can choose from and are expected to use, in most cases, it's about coordinating and personalizing your care. More than 700 doctors, many other health care providers, and all four hospitals in Monterey County are part of the Aspire Health Plan network.
Myth #5: Medicare Advantage plans are only for seniors in excellent health
Original Medicare can't deny you because of a pre-existing disease or condition. Medicare Advantage plans cannot deny coverage based on health status. Medicare Advantage plans also offer care coordination and disease management, which can help those living with chronic conditions. Also, beginning in 2021, all eligible beneficiaries with End-Stage Renal Disease (ESRD) can now enroll in a Medicare Advantage plan.
Myth #6: All Medicare Advantage plans are the same
The most critical differences between Medicare Advantage plans are provider networks, prescription drug coverage, and premiums (and the extra benefits included in the schedule). Plan sponsors like Aspire Health Plan also offer different plan options to meet your needs better. If you're interested in joining a Medicare Advantage plan, you'll need to make some plan comparisons to determine which method best fits your needs and preferences.
Myth #7: Medicare Advantage plans can make changes to your health coverage without telling you
Each year, before the start of Open Enrollment (October 15 – December 7), Medicare Advantage plans contact enrollees to notify them of changes to their Medicare Advantage plan through the Notice of Annual Change (ANOC) detailing changes in the plan's benefits for the following year.
Myth #8: When choosing a Medicare Advantage plan with Part D (MAPD) coverage, drug lists, and drug costs aren't readily available
Most Medicare Advantage plans offer Part D coverage in a combined policy known as an MAPD plan. When looking for an MAPD plan, you can use the Medicare Plan Finder Tool or contact a specific plan to find out if the prescription drugs you need are included in the drug list they offer. There is also an Extra Help program to help you pay for drug program costs, like premiums, deductibles, and coinsurance.
Myth #9: Medicare Advantage plans don't offer dental, vision, or hearing coverage
Original Medicare does not offer vision, hearing, or dental benefits. Most Medicare Advantage plans offer these benefits. Plus, Medicare Advantage plans can now add extra benefits not included in regular Medicare, like transportation, chiropractic, acupuncture, and fitness options.
Myth #10: Once you join a Medicare Advantage plan, you can't change your coverage
You can change plans during the Annual Election Period (AEP) or return to Original Medicare each year. You may also qualify for a Special Enrollment Period (SEP) if you move into, leave, or reside in a skilled nursing facility (SNF) or long-term care (LTC) hospital or if you move out of an area geographic.
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