Washington D.C. Medicare Advantage Plans Explained
Unlike Original Medicare, which only covers major medical, a Medicare Advantage plan can include many extras, including prescriptions, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in Washington D.C..
Althought the extra benefits are nice to have, it's important to fully understand what you're getting if you join a Medicare Advantage plan in Washington D.C.. Specifically, Medicare Advantage is managed care health insurance and the plan controls your access to healthcare providers. If you have ever had an HMO plan through your employer's group health insurance, you have a good idea of what managed care is all about.
Medicare vs. Medicare Advantage: What's the Difference?
The big differences between traditional Medicare coverage and what you get with Medicare Advantage are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.
Medicare Advantage vs. Medicare: The Pros and Cons
- Doctor Choice:
- Medicare Advantage: Must use healthcare providers within the plan's network.
- Original Medicare: Use any Medicare-approved provider you choose.
- Medicare Advantage: Each plan can charge what they want for copays and coinsurance, making it challenging to compare actual costs.
- Original Medicare: Coinsurance and deductibles are predictable and you can get a Medicare supplement to help pay these costs.
- Medicare Advantage: You're protected by the plan's annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance for the rest of the year.
- Original Medicare: No out-of-pocket limit.
- Medicare Advantage: Most plans come bundled with a Medicare Part D plan for prescription coverage.
- Original Medicare: You must buy a stand-alone Medicare Part D plan.
- Medicare Advantage: You're covered for travel emergencies within the USA but not for routine doctor visits outside of your home county.
- Original Medicare: You're covered anywhere you go in the USA and its territories.
Medicare Advantage vs. Medigap
Most Washington D.C. seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take a minute or two to compare and contrast, shall we?
Why Washington D.C. Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in Washington D.C. choose Medicare Advantage.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people and for people who qualify for both Medicare and Medicaid.
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.
What are the Disadvantages of Washington D.C. Medicare Advantage Plans?
We have already highlighted the issue of doctor choice in Medicare Advantage. If this is not an issue for you, then consider the financial differences.
Medicare Advantage plans have a monthly premium, but it's generally less than a Medicare supplement, and some plans even have a $0 premium. But, you also pay when you use health care. These are the copays.
With a Medicare supplement plan you pay most of your costs in advance with monthly premiums. Depending on the level of coverage you choose, the plan can cover all of your copays, coinsurance, and deductibles except the annual Part B deductible. This makes your monthly healthcare costs more predictable, particularly if or when you have serious health problems.
Which is Best in Washington D.C., Medicare Advantage or Medicare Supplement Insurance?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About Washington D.C. Medicare Advantage Plans
Medicare Advantage plans vary from County to County in Washington D.C.. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
Most Medicare Advantage plans available in Washington D.C. include a Part D plan, but not all. Before joining a plan, be sure to check that all of your most important medications are covered. You can do that with this tool.
Some people love Medicare Advantage while others hate it. The only way to determine if it will work for you is to compare your health and financial situation with the plans available in your area. In this article you will learn how to do just that.