Medicare Advantage

Here is the Big Question: Can Medicare Advantage Plans Deny Enrollment?

When you’re considering what Medicare Advantage plans are and whether to enroll, one of the first questions that might pop into your head is, “Can Medicare Advantage plans deny enrollment?”

Understanding how Medicare Advantage works and the ins and outs of the Medicare Advantage enrollment process can save you a lot of headaches down the line.

Key Takeaways

• Don’t Miss Out – Plans can deny enrollment if you miss deadlines, provide incorrect info, or don’t meet eligibility.
• You’re Protected – Guaranteed issue rights and the appeals process can help if you qualify.
• Get Expert Help – Your local Medicare office can guide you through eligibility and enrollment.

The Basics of Enrollment Eligibility

Medicare Advantage plans, also known as Medicare Part C, are designed to offer additional benefits beyond Original Medicare. However, they have their own set of Medicare Advantage rules and application processes. 

Here’s what you need to know:

Application Process: 

The process involves providing accurate and complete information during Medicare Advantage open enrollment  or other enrollment periods. Any mistakes or omissions can result in enrollment restrictions or even a denial

Common Reasons for Denial

Even if you’re generally eligible, there are several reasons why a Medicare Advantage plan might deny your enrollment:

• Missed Deadlines: If you miss the three enrollment periods for Medicare or any Special Enrollment Period, your application could be denied
• Incorrect Information: Inaccurate or incomplete details on your application can lead to a denial
• Residence Outside Service Area: Plans have specific geographic service areas, such as Medicare Advantage plans in California
• Plan-Specific Requirements: Some plans have additional criteria related to your previous coverage

Questions and Answers: Clearing Up Common Concerns

Q: Can Medicare Advantage deny coverage after enrollment?

A: While initial enrollment is protected for eligible individuals, coverage for specific services may require prior authorization.

Q: Can I enroll in a Medicare Advantage plan anytime?

A: No, you must enroll during specific Medicare Advantage open enrollment periods unless you qualify for a special enrollment period.

Q: What should I do if my application is denied?

A: Contact the plan immediately about the Medicare Advantage appeal process. Many denials are due to simple clerical errors.

How to Prevent Denials

Preventing enrollment denials starts with being prepared and informed. Here are some practical steps:

• Verify Your Information: Before submitting your application, review all your information
• Know Your Deadlines: Keep track of when Medicare enrollment ends and other key dates
• Understand Local Guidelines: Medicare Advantage enrollment restrictions may vary by region

Ask Questions: Don’t hesitate to ask about how to change Medicare Advantage plans or consult with a Medicare expert

Additional Frequently Asked Questions

Q: Can you go back to Original Medicare from an Advantage plan?

A: Yes, you can switch from Medicare Advantage to Original Medicare during certain enrollment periods.

Q: What about Medicare Advantage Special Enrollment?

A: Special enrollment periods are available for qualifying life events or circumstances.

Q: Do Medicare Advantage plans require medical underwriting?

A: Generally no, though some specialized plans may have additional requirements.

The Role of Local Support

Local Medicare enrollment offices play a vital role in helping beneficiaries understand how to enroll in Medicare Advantage.

They can provide:

• Workshops and Seminars: These sessions explain when you can enroll in a Medicare Advantage plan
• One-on-One Guidance: Personalized consultations about changing Medicare Advantage plans
• Localized Updates: Information on when is open enrollment for Medicare Advantage plans and other important dates

If you’re interested in learning more about the broader Medicare landscape, check out our other articles:

Final Thoughts

While it might seem frustrating that Medicare Advantage plans can deny enrollment under certain circumstances, understanding who qualifies for Medicare Advantage and the reasons behind these decisions can empower you to take control of your healthcare journey. 

By being proactive—verifying your information, keeping track of when the Medicare Advantage enrollment periods occur, and utilizing local resources—you can navigate the Medicare Advantage application process with confidence.

Remember, if you encounter any issues with Medicare Advantage enrollment, don’t hesitate to reach out for help. 

Whether it’s through an appeal process or by consulting your local Medicare enrollment office, support is available to help ensure that you receive the coverage you deserve. 

With the right information and preparation, you can overcome enrollment hurdles and secure a Medicare Advantage plan that meets your needs.

Senior Benefit’s Hagerstown Office

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(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

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(301) 271-4040

112A E Main St
Thurmont, MD 21788

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

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(301) 722-1414

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Cumberland, MD 21502

Hours :

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How to Enroll in a Medicare Advantage Plan in Maryland

Looking to enroll in a Medicare Advantage plan in Maryland? You’re not alone. 

We simplify Medicare enrollment for thousands of Maryland seniors across Hagerstown, Thurmont, Cumberland, and beyond to secure the right coverage.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

(301) 271-4040

112A E Main St
Thurmont, MD 21788

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

(301) 722-1414

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Lately, some have wondered if Medicare Advantage Plans are bad. If you have been reading the news lately you have likely seen articles that are talking about how many seniors feel ‘trapped’ in a Medicare Advantage plan.  We all know that bad news sells while people often overlook good news.  

The reality is that the truth usually lies somewhere in between.  This article decodes the pros and cons of Medicare Advantage plans, aiding your decision-making process.   As you approach your golden years, the many decisions surrounding your healthcare can be both complex and crucial.

Among the myriad of choices, selecting the right Medicare plan is one of the most significant. Lately, Medicare Advantage (MA) plans have stirred up quite the debate, with opinions ranging from godsend to the scourge of elders’ healthcare.

But let’s dive deeper into the sea of healthcare options—do Medicare Advantage plans deserve their mixed reputation?

The Beginning of Medicare Part C: The BalancedBudget Act

If we start from the beginning, the Balanced Budget Act of 1997 (BBA) introduced Medicare Part C (now known as Medicare Advantage) and to put it mildly became a bit of a disaster.  Seniors flocked to these plans for primarily one reason, the prescription drug coverage benefit.  Of course, the low cost of many of these plans didn’t hurt either.  Over the months, it was a bit of the wild West and insurance companies were offering crab and even steak dinners to seniors just to come hear about the plans.  Many folks signed up right at the dinners and jumped head first into these new plans. 

Suddenly many of these Medicare beneficiaries were smacked in the face with why these plans were so low costing.  Unlike original Medicare, these Part C plans required seniors to use a doctors who participated in the plan’s network.  Since many of these carriers rushed their plans to market, the networks were very small.  Many seniors were having to pick a new doctor and give up the ones they felt comfortable with.  In addition to network issues, folks were also now dealing with pre-authorization requirements to continue to see a specialist for their more complicated health issues. The one thing that kept them in the plan was the prescription drug benefit, which at that time was one of the only ways that seniors could get help with the high costs of their prescriptions.  Sadly these plans quickly started to exit the market and seniors went back onto original Medicare and paying for all of their prescriptions out of pocket.

In 2003 Medicare Advantage and stand-alone Part D prescription drug plans were introduced back into the market.  If you are thinking that Medicare Advantage was basically a rebranding of Medicare Part C then you are on the right track.  The problem once again was the lack of robust networks and many doctors pushing back against joining them.  Many seniors remembered the fiasco of Medicare Part C back in the 1990s and were hesitant to enroll in the newer Medicare Advantage plans even though these plans had low daily hospital co-pays and reasonable maximum annual out of pocket limits for the plans.  By the end of 2004 out of the 41 million Americans on Medicare only about 5 million were enrolled in a Medicare Advantage plan.

Fast forward to 2023 and out of the 65 million Americans enrolled in Medicare just under 32 million were enrolled in a Medicare Advantage plan.  In less than 20 years there has been an increase in Medicare Advantage plan members of 540%.  That is quite a remarkable number.

How they differ from Original Medicare

The primary distinction lies in how they manage and pay for your healthcare benefits. While Original Medicare allows direct payment for healthcare goods and services, Medicare Advantage (MA) contracts with a network of providers, which dictates your access to care.

This basically means that instead of original Medicare paying benefits to your doctor, they are paying all your Medicare annual allowance to the Medicare Advantage plan you have enrolled in.  It is then up to the MA plan to manage your healthcare costs. 

If you have more expenses than what was paid by Medicare to the MA plan, then the plan loses money on you.  If you have a healthy year then the MA plan makes money. 

Additionally, MA plans receive federal subsidies from the Centers for Medicare and Medicaid Services (CMS) which helps with their profitability.

Pros of Medicare Advantage Plans

Despite their critics, Medicare Advantage plans have numerous advantages that make them a worthy competitor against Original Medicare. Let’s unpack these benefits to show a balanced side of the story.

Lower out-of-pocket costs

The financial burden of healthcare can be significant for seniors. Medicare Advantage plans cap out-of-pocket spending for Part A and B services, providing predictability in healthcare costs. We know these caps as the plan’s Maximum Out of Pocket (MOoP).

This can be especially beneficial for those who face chronic health conditions that necessitate frequent doctor visits or hospital care.  When an individual is covered only by Medicare Part A and Part B (without a Medicare Supplement) they do not have an annual cap.

Care Coordination

Another plus of Medicare Advantage is the focus on care coordination. Some plans offer nurse hotlines, wellness programs, and other resources to help beneficiaries manage their health more effectively. The attention to coordination can reduce medical errors and can make the patient experience smoother.

Cons of Medicare Advantage Plans

While the benefits paint a rosy picture, it’s crucial to address the drawbacks. Medicare Advantage plans have their shortcomings and may not suit everyone perfectly.

Limited provider network

Enrolling in a Medicare Advantage plan often means adhering to a specific network of doctors and hospitals. This can be restrictive, particularly for those who have established relationships with healthcare providers.

While the networks have become more robust over the last 20 years, they still pale in comparison to the number of providers who accept original Medicare.  It’s essential to ensure that your preferred healthcare professionals are part of the plan’s provider network. 

If the MA plan you are looking at uses an HMO network, then you need to understand that if you see a provider not in the plan’s network, then you are responsible for 100% of the medical bills. 

Since CMS directly pays all your benefits to the MA plan, you can’t ask Medicare to cover the costs.

Potential for higher costs in certain situations

While MA plans offer a ceiling for out-of-pocket costs, they can also lead to higher expenses if care is sought outside the network.

Emergency care and urgent care services can potentially not be as covered as well as with the traditional Medicare program, which doesn’t have the same provider restrictions.  As we mentioned earlier, an HMO network is the most restrictive and requires you to use a provider that participates in the plan’s network. 

If your MA plan uses a PPO network, then you would have coverage when using a provider not in-network.  There are serious pitfalls that you need to be aware of when using a non-participating provider. 

Most plans have a separate maximum out of pocket cap for in-network vs out-of-network.  The MA plan may have a MOop of $7,000 for in-network, but a separate MOop of $10,000 for out-of-network. 

In addition, seeing an out-of-network provider can be billed differently.  Instead of paying a $50 co-pay for the specialist, you might be required to pay 20% of the cost.  These situations can lead to much higher amounts of expenses being paid out of pocket.

Annual changes in plan coverage

Medicare Advantage plans can alter their coverage on a yearly basis, including prescription drug formularies and benefits. This means they may not cover next year what they coveredd this year.

A Medicare Advantage plan does an annual contract with CMS, which means that they can choose not to continue to offer the plan in a certain county or even state.  This means all those enrolled in that plan would have to find a new plan or return to original Medicare. 

Beneficiaries need to review their plans and potentially switch annually, causing potential inconvenience and confusion.

Considerations for Seniors

You may wonder what all this means for you. How do you know if Medicare Advantage is the right choice? The answer to this question, as we often find in healthcare, is that it depends. Here are some factors to consider when navigating the maze of Medicare Advantage options.

Factors to consider when deciding on a Medicare Advantage plan

1. Your health status – If you’re relatively healthy, you may find that the additional benefits of an MA plan are more advantageous. However, those with more complex or severe health needs might prefer the flexibility and broader coverage of Original Medicare. 

   A key point to remember is that your focus should be the core benefits of the plan and not the add-ons.  Many times, the add-ons are the ‘sizzle’, but you need to be more concerned with the ‘steak’. 

   Don’t get us wrong, having dental benefits is great, but if your plan makes you responsible for a daily co-pay of $350 for up to 5 days in the hospital, those extra benefits quickly dry up. 

   An example of this would be having $1,500 of dental benefits but ending up in the hospital for 5 days with a $350 per day co-pay.  This hospital stay would mean you having to come up with $1,750 out of your own pocket.

2. Location – Provider networks can vary widely by geographic area, so where you live can significantly affect your choice of MA plan.

   Rural areas, for example, may have more limited options than urban centers.  In fact, we have found that in many rural areas, doctors are less likely to join a plan’s network.

3. Your lifestyle and health care preferences – If you have specific needs or prefer a particular style of care, such as integrative or alternative medicine, you’ll want to ensure that the MA plan you choose aligns with those preferences.

How to evaluate plan options

Diving into the details is essential. Look beyond the surface benefits and consider the cost-sharing arrangements, such as premiums, deductibles, co-payments, and coinsurance.

• Does the plan cover the specific services and treatments you anticipate needing?
• How easy is it to access care if you’re out of town or need a specialist?  
• Does the plan cover all your prescriptions in their formulary? 
• Does the plan require you to do step-therapy? (trying other lower costing prescriptions before the plan will pay for the higher priced one you want). 

These are just a few of the aspects that require thorough examination.

Comparing Medicare Supplement to Medicare Advantage

Everything we discussed above is comparing original Medicare Parts A and B to Medicare Advantage.  The reality is that most folks on original Medicare also have a Medicare Supplement plan.  When you do a comparison between a Medicare Supplement and a Medicare Advantage plan, things change dramatically.

Read our article Medicare Supplements vs Medicare Advantage Plans

Frequently Asked Questions (FAQs)

• Why are people against Medicare Advantage plans?
  • One of the biggest issues folks have with Medicare Advantage plans after they enroll in one is the use of networks.  Under original Medicare there are no networks, so you can see any provider who accepts Medicare. 
• What is the downside of a Medicare Advantage plan?
  • Besides network restrictions, needing a referral or prior authorization to see a specialist is a major downside.  A Medicare Advantage plan typically requires these, but original Medicare does not.
• Why are people leaving Medicare Advantage plans?
  • There are several reasons why people leave Medicare Advantage plans and return back to original Medicare include such things as:
    • Prior-authorization requirements
    • Procedure denied by the plan
    • Doctors complaining to their patients about the plan (such as slow payment from the insurance carrier)
• Is Medicare Advantage under investigation?
  • In 2023 several Medicare Advantage plans came under scrutiny by the Senate for several issues:
    • Use of an algorithm to deny care that patients need.
    • Overbilling Medicare by saying that members were sicker or had illnesses that they really didn’t have which allowed the plans to be paid a higher rate.  This abuse was documented in a report from MedPac that was sent to Congress.
• Can I drop my Medicare Advantage plan and go back to original Medicare?
  • Yes, but there are certain restrictions that you must adhere to.
    • During the Annual Enrollment Period (AEP) which runs from October 15^th – December 7^th of each year, you can drop an existing Medicare Advantage plan and return back to original Medicare and enroll in a stand-alone Part D prescription drug plan.
    • If you enrolled for the first time in a Medicare Advantage plan you can disenroll within the first 11 months and return back to original Medicare and enroll in a stand-alone Part D prescription drug plan.
• Is Medicare Advantage draining Medicare?
  • In a report written by the Center for Economic and Policy Research it was reported that an individual on a Medicare Advantage plan costs Medicare more each year than an individual still on original Medicare. 

    The study cites that in 2020 CMS spent $1,538 more per Medicare beneficiary enrolled in a Medicare Advantage plan than it would for that same person to be enrolled in original Medicare.

So What Can We Conclude Regarding Medicare Advantage Plans?

Are Medicare Advantage plans really that bad? The truth, as always, is somewhere in the middle. They offer a host of advantages, including cost containment, supplemental benefits, and improved care coordination.

However, they also come with their share of inconveniences, such as provider network restrictions and the potential for increased costs under certain circumstances. It’s not about good or bad; it’s about what aligns best with your individual needs and preferences.

Contact Senior Benefit Services today at (800)924-4727 to see what type of plan is best for your personal needs.

Senior Benefit’s Hagerstown Office

We are here to help. Contact us today!

(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

(301) 271-4040

112A E Main St
Thurmont, MD 21788

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

(301) 722-1414

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

For millions of Americans, Medicare is a critical safety net, helping to shoulder the burden of healthcare costs as they move into their senior years.

But despite its comprehensive reputation, there’s a surprising array of medical services and treatments that original Medicare doesn’t cover.

These gaps in coverage can lead to unforeseen expenses, leaving beneficiaries vulnerable and in need of additional insurance solutions.

In this guide, we’ll take a deep dive into what’s not included in that iconic Medicare coverage, and what you can do to bridge the coverage gap.

Here’s a comprehensive look at the services and treatments that you may not know are excluded from your Medicare plan—but perhaps should.

1.) Long Term Care

A common misconception is that Medicare provides for long-term care, but it does not. Medicare coverage is limited to short-term skilled nursing facility care following a hospital stay. Long-term care options typically must be financed through other means, such as long-term care insurance, Medicaid (for those who qualify), or out-of-pocket payments.

2.) Foreign Travel

When venturing beyond the borders of the United States, you will find that Medicare coverage is limited. With a few exceptions for emergency situations close to the US border or on a cruise ship, health care received abroad is not covered by traditional Medicare plans.

3.) Routine Foot Care Coverage

Services such as foot exams or treatment for conditions like flat feet, corns or calluses, are generally not covered under original Medicare. Only foot care that’s considered medically necessary, such as diabetic-related issues, may be included.

4.) Routine Vision Coverage

Medicare generally does not cover routine eye exams or eyeglasses/contact lenses. However, it may cover a yearly eye exam if you’re at high risk for glaucoma or diabetic retinopathy.

For those who desire vision coverage, additional vision plans or Medicare Advantage Plans with vision benefits are available.

In addition, there are many combo plans that cover vision, dental, and hearing benefits that can be purchased in addition to any other health insurance coverage that you might have.

5.) Routine Dental Coverage

Don’t expect Medicare to pick up the tab for routine dental visits, cleanings, fillings, or dentures.

These are out of pocket costs unless you have a separate dental insurance policy or a Medicare Advantage Plan that offers dental benefits.

6.) Hearing Aids Coverage

The cost of hearing aids can be substantial, but Medicare does not cover hearing aids or the exams needed for fitting them.

Some Medicare Advantage Plans may provide supplemental hearing coverage.

Just like Medicare not covering routine dental coverage, you can also purchase a separate combo policy that will provide coverage for hearing benefits.

7.) Prescription Drug Coverage

Original Medicare, made up of Part A and Part B, does not include coverage for most prescription drugs

. To get this coverage, you can enroll in a separate Medicare Prescription Drug Plan, known as Part D, or choose a Medicare Advantage Plan that includes drug coverage.

Some key points to always consider when shopping for Prescription Drug Coverage (Part D) are:

• The lowest monthly premium doesn’t necessarily mean the lowest total out-of-pocket costs for the year. Some low-priced plans have higher co-pays than others.
• Keep an eye on what tiers your prescriptions fall into. One plan may have your drug listed as a Tier 1 (lowest co-pay), but another might have it listed as Tier 2 (higher co-pay).
• Make sure all your drugs are covered on the plan’s formulary.

Beyond What Medicare Does Not Cover

Knowing what Medicare doesn’t cover allows you to explore supplementary insurance options and make necessary financial plans. For additional coverage, consider Medicare Advantage Plans or separate policies that fill these gaps.

It’s essential to perform due diligence and determine the best choice for your health and budget. Always consult with a knowledgeable Medicare advisor or insurance professional before making decisions about your health care coverage.

Stay informed and plan for what Medicare doesn’t provide, ensuring you have comprehensive healthcare coverage that meets your needs throughout your golden years. Call Senior Benefit Services, Inc. today at (800)924-4727 to make sure you have the coverage you need.

Many retirees want to know if Medicare will cover the cost of dentures. Medicare provides comprehensive healthcare but offers notably limited dental care benefits. This article delves into the extent of dental coverage under Medicare, shedding light on the options available for individuals seeking dental care.

The Scope of Medicare Dental Coverage

Medicare, established in 1965, was not designed to cover routine dental care, including dentures. At that time, authorities did not consider dental care routine medical care.

A 1980 Congress statute highly restricts Medicare’s dental coverage due to a dental exclusion. As a result, Medicare seldom covers dental procedures like extractions and fillings, which are essential for maintaining oral health.

Medicare does not cover denture costs, deeming them not medically necessary under Parts A and B.

Will Dental Ever Be Covered Under Medicare?

Factors prevent the inclusion of dental benefits under Medicare, despite widespread desire. It is important to keep in mind that there are almost 66,000,000 people on Medicare.1  Yes, you read that correctly….66 million! 

To cover one dental visit of $120.00 for each Medicare beneficiary, taxpayers would have to fund an additional $7,920,000,000.00 into Medicare.  Taxpayer dollars fund programs like Medicare and Social Security, as we all know.

So where do we come up with another $8 billion dollars to cover $120 per person in dental bills?  If you answered raising taxes, then you are on the right page.

So how much are dentures.  Roughly a complete set of ‘mid-priced’ dentures costs between $1,000 – $3,000.  A single denture plate can run between $500 – $1,500.2

Just using these costs for a complete set of ‘mid-priced’ dentures and not for a ‘premium’ set, here is how it would look for providing this to just 10% of the Medicare beneficiaries.

65,748,297 Medicare beneficiaries x 10% = 6,574,829 sets of dentures

6,574,829 sets of dentures x $2,000 (average of ‘mid-priced’ dentures) = $13,149,658,000.00 in additional costs for 1 year.

Offering dental coverage through Medicare, including routine visits and dentures for 10%, will require taxpayers to fund an additional $21 billion.

Last, but not least, the American Dental Association is against this proposal since it would likely result in pay cuts to dentists.

Options for Dental Coverage Under Medicare

Given Medicare’s limited dental coverage, individuals have a few options to consider for their dental care needs:

Self-Pay

Many Medicare recipients choose to pay out-of-pocket for dental services, especially those with generally healthy teeth who may only require routine cleanings.

Some may opt for dentists’ internal plans, which can offer a number of cleanings per year and discounts on other services.

Private Insurance

Dental insurance plans provided by insurance companies typically run between $25 – $75 per month depending on the level of benefits you are wanting. 

Most plans provide 100% coverage for preventive services such as routine exams, cleanings, and bitewing x-rays.  For items that fall under basic care, such as fillings and simple extractions, many carriers will cover these benefits at 80%. 

It is important to keep in mind that some plans do have a 6-month waiting period before they will cover these services.

Most plans cover major care at 50% with a possible 12-month waiting period for these services. Major services can include crowns, bridges, dentures, implants and more. You read that correctly, while Medicare does not cover dentures, a private dental plan can.

Final Thoughts

While we can always hope that one day we will be able to find a way for Medicare beneficiaries to have complete dental coverage, it is important to act and not wait until you are possibly burdened with thousands of dollars in out-of-pocket expenses.

Now you know that Medicare will not cover dentures, so it might be time to look at other options.

Give us a call today at (800)924-4727 to discuss your options.

Sources

1. Center for Medicare Advocacy: https://medicareadvocacy.org/medicare-enrollment-numbers/#:~:text=The%20Centers%20for%20Medicare%20%26%20Medicaid,are%20enrolled%20in%20Original%20Medicare.
2. Dentureliving.com: https://www.dentureliving.com/en-us/advice-tips/preparing-for-dentures/costs/how-much-do-dentures-cost

Are you a senior citizen wondering how much Medicare Part C will cost you? You’re not alone! Many seniors have questions about the costs and plan options associated with this important part of their healthcare. In our 2024 guide to Medicare Part C, we’ll explain the sample premiums as well as other fees that go into determining your exact out-of-pocket expenses for these plans. We’ll reveal the services Medicare Part C covers and guide you to choose the plan best fitting your needs. Don’t worry; understanding the costs associated with your healthcare can be simple!

Examples of Monthly Premiums for Medicare Advantage Plans

Expect an average premium range with Medicare Advantage (Part C), though costs can vary based on location and specific plan. In many cases, beneficiaries can still find plans with $0 premiums. Although the average Medicare Advantage premium in 2024 is around $30 to $40 per month. For instance, Carrier 1 Medicare Advantage Plan using an HMO network offers a $0 per month premium, but it’s limited to certain counties within each state. A different plan, Carrier 2 using a PPO network has monthly premiums that start around $35. It’s essential to remember that a lower premium often means higher out-of-pocket costs when you need care and/or a more restrictive network. Therefore, it’s crucial to balance the monthly premium with other expenses such as deductibles, copayments, and coinsurance when choosing the right Medicare Advantage plan for you.

Overview of Medicare Part C – what it is and who can get it

Getting older comes with various challenges, including healthcare needs. That is where Medicare Part C comes into play. Also known as Medicare Advantage, Part C is an alternative to Original Medicare (Part A and Part B). It is a health insurance plan offered by private insurance companies approved by Medicare, which covers all of the benefits offered in Part A and B. On top of that, it can offer additional benefits, such as dental, vision, or hearing, at an affordable cost. Remember, only those enrolled in both Medicare Parts A and B qualify for Part C.

It’s essential to understand the fundamental difference between a Medicare Advantage plan (Part C) and a Medicare Supplement (Medigap) plan. While both are intended to help cover out-of-pocket costs of Original Medicare (Part A and Part B), they function in entirely different ways. A Medicare Advantage plan is an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. It often includes additional benefits such as prescription drug coverage, as well as dental, vision, or hearing services. On the other hand, a Medicare Supplement plan works in conjunction with your Original Medicare benefits. This is to help pay for the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. It’s paramount to consider the differences, costs, and benefits of these options to make the best decision based on your healthcare needs and financial situation.

Understanding the different components of Medicare Part C coverage

Understanding Medicare Part C coverage is crucial for those who qualify for this program. Made available through private insurance companies, it combines the benefits of both Medicare Part A and Medicare Part B. Medicare Part A primarily covers inpatient hospital care, hospice care, and skilled nursing facility care. Medicare Part B, on the other hand, covers outpatient services, preventative services, and medical equipment. With Medicare Part C, you get an opportunity to customize your coverage by selecting a plan that fits your individual needs as well as budget. It can provide additional benefits, such as prescription drug coverage, vision, dental, and hearing care. By understanding the different components of Medicare Part C coverage, you can make an informed decision regarding which plan is right for you.

Factors that affect the cost of Medicare Part C

When it comes to Medicare Part C, many factors can influence the cost of coverage. The first thing to consider is the plan itself. Different Medicare Advantage plans have varying benefits, co-payments, and deductibles, all of which affect the monthly premium cost. Another factor is location. Insurance companies can charge different rates in various parts of the country, based on the cost of medical care in that region. Age, health status, and income level can also affect the cost, particularly for those who qualify for financial assistance. For those with a chronic health condition, there are plans designed just for those conditions. Some of these conditions include diabetes and heart complications. Ultimately, it’s essential to carefully evaluate all of these factors before choosing a Medicare Part C plan to ensure that you are getting the coverage you need at a price that fits your budget.

How to choose a plan based on your budget and needs

Choosing the right plan for your budget and needs can be overwhelming. With the help from an informed advisor it doesn’t have to be. First, assess your needs and priorities. Do you prioritize flexibility or a lower monthly cost? If provider flexibility is a priority, then a Medicare Advantage plan that uses a Preferred Provider Organization (PPO) network will allow you to see providers in and out of network. If your priority is cost then a plan that uses a Health Maintenance Organization (HMO) network will likely give you the lowest co-pays and premium costs. Next, take stock of your current health and lifestyle. Are you relatively healthy and rarely need to visit the doctor, or do you have ongoing medical needs? Once you understand your priorities and needs, your advisor can find a plan that aligns with them. This may include assessing factors like premiums, deductibles, and co-pays. Taking the time to choose the right plan can save you both time and money in the long run.

Common Misconceptions about Medicare Part C

Despite the widespread use of Medicare Part C, multiple misconceptions continue to circulate, which can make the decision-making process more challenging for individuals. One common misconception is that Medicare Advantage (Part C) plans are fully comprehensive and eliminate all out-of-pocket costs. Indeed, these plans often surpass Original Medicare in coverage, but they usually come with deductibles, co-pays, and other costs. Depending on things such as what state and county you reside in, you will hear about different Maximum Out Of Pocket (MOOP) costs. There are plans in some states and counties that have a $3,000 MOOP for a calendar year, but in another state and county that MOOP could be well over $7,000 for a calendar year.

Misconception 2

Another misconception is that all Medicare Part C plans are the same. In reality, plans can differ significantly, with various offerings, premiums, and out-of-pocket costs, depending on the insurance company and location. It’s crucial to investigate the specifics of any plan you’re considering to ensure it will truly meet your needs. Some plans offer a gym membership such as Silver Sneakers, but another may not. While some plans may offer dental benefits of up to $1,000 at no additional cost, another plan may offer $2,000. Now keep in mind that the Medicare Advantage plan offering the gym membership might only offer up to $1,000 in dental benefits. If you don’t need or want the gym membership but really want more dental benefits, then you would likely want to go with the plan that offers up to $2,000 in dental benefits. If you really want both the gym membership and the maximum dental benefits, you might want to consider getting the plan with the gym membership and adding on additional dental benefits with a stand alone dental plan.

Misconception 3

A third misconception is that Medicare Part C enrollees can see any healthcare provider. However, most Medicare Advantage plans are network-based, meaning your provider options may be limited. It’s important to make sure your preferred providers are in-network or be comfortable with the network providers before choosing a plan. As we discussed earlier, most plans will use either a PPO or HMO network. If you join a plan that uses an HMO network, then you MUST see only providers who participate in that plan’s network. If you go with a PPO plan then you will have the lowest out of pocket costs when going to a provider in their network, but you do have the option of seeing a provider who is not in that network. “Keep in mind, choosing an out-of-network provider often means facing a separate deductible and higher coinsurance payments.”

Misconception 4

Finally, some believe that once enrolled in Medicare Part C, they are locked in forever. The reality is, enrollees have the option to change plans during the annual enrollment period. This flexibility allows individuals to adapt their coverage as their healthcare needs evolve. Each year the annual enrollment period (AEP) begins October 15th and ends December 7th. During this time you can switch Medicare Advantage plans or leave Medicare Part C completely and return to original Medicare. Remember that if you return to original Medicare and want a Medicare Supplement you may be subject to underwriting. This means you will have to medically qualify for the Medicare Supplement. There are provisions for certain situations where you could obtain a Medicare Supplement plan without underwriting.

By dispelling common misconceptions, you can make informed decisions and maximize your Medicare Part C coverage.

Tips for saving money on Medicare Part C coverage

Medicare Part C can be a great way to get comprehensive health coverage. However, it can also be costly. If you’re looking for ways to save money on your Part C coverage, one option to consider is hospital indemnity insurance. This type of insurance provides additional coverage for hospital stays, which can be a major source of expense when it comes to healthcare. Did you know that daily hospital co-pays can vary from $200 per day to over $400 per day? At $400 per day a 5 day inpatient hospital stay would amount to a $2,000 exposure that would need to be paid out of pocket.

By adding hospital indemnity to your Part C plan, you can help avoid paying unexpected costs out of pocket. Learn how a hospital indemnity plan could pay your daily hospital co-pays for pennies on the dollar.

Indeed, Medicare Part C outshines regular Part A and B by providing coverage as a valuable alternative to original Medicare. It is important research your plan’s components and understand your monthly and out-of-pocket costs. There are a variety of options available from private companies, so it’s worth considering which one will cover your needs best. Doing this allows you to save time and money while finding the right plan for your situation. Additionally, there are several strategies you can use to save money on your out of pocket expenses. Learn more about Medicare Part C; call (800) 924-4727 to find the best plan.