Nancy and Ralph are turning sixty five and they elected to go with a Medicare Supplement primarily because of the freedom of choice of doctors and hospitals. Two years later, they were satisfied with how their Medicare Supplement was working for them. But after reviewing their budget, they decided to switch to a Medicare Advantage PPO Plan that does not require a monthly premium. One month later, Ralph developed cardiac problems and needed to go to the hospital. Three months later, Nancy fell and broke her hip.
Ralph wanted to be under the care of a certain Cardiologist and go to a particular hospital. He learned that the Cardiologist and the hospital were not in the Medicare Advantage provider network. At the time he signed up for the Advantage Plan that particular Cardiologist and hospital were in the provider network. Ralph was prescribed certain cardiac medications and learned that not all of them were covered in his Medicare Advantage plan. After Nancy’s hip surgery, her doctor wanted to send her to a particular rehab facility where he sends all of his patients. That rehab facility was not in the Medicare Advantage provider network.
What happened was that Ralph and Nancy got the care they needed. Their out of pocket costs were more than they anticipated. At the end of the year, the difference in the cost of what they paid out of pocket for their Medicare Advantage Plan compared to the cost of their monthly premium for their Medicare Supplement was a few hundred dollars. They wanted to switch back to the Medicare Supplement but did not medically qualify because of their medical history the past year.
Medicare Advantage Plans (also referred to as “Medicare Part C”) are offered by private insurance companies that have been approved by Medicare. The most common types of plans are HMO Plans and PPO plans. They combine hospital care, doctor’s visits and other outpatient care in a single plan. Many of the Medicare Advantage Plans offer prescription drug coverage as well.
With some of the Medicare Advantage Plans, there is no monthly premium. You pay a fixed dollar amount as you go to the doctor or hospital. Each plan has an annual maximum out of pocket amount of money that you are responsible for. For anyone that is interested in finding out more information, I will be happy to answer your questions when you contact me.
