What are Medicare Advantage Plans and Can I Get One in Maryland?
Traditional Medicare covers about 80% of all major medical costs. It does not cover minor medical for things like vision, hearing, dental, and prescriptions. The Medicare Advantage plans available in Maryland can include minor medical benefits, but are not required to. Most do include coverage for prescriptions.
While it is nice to have coverage for minor medical costs, it is critical that you understand exactly what you get when you join a Medicare Advantage plan in Maryland. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care plan (HMO, PPO, etc.) through an employer, then you already know what to expect.
Medicare Advantage vs. Medicare: Is There a Big Difference?
The best way to understand the differences between Medicare Advantage and traditional Medicare is to evaluate the pros and cons of each type of coverage.
Pros and Cons: Medicare vs. Maryland Medicare Advantage Plans
- When you have Original Medicare you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Maryland providers.
- If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Maryland Medicare Advantage plans, which are only required to cover you if you have a medical emergency.
- With OriginalMedicare there are no limits on your out-of-pocket costs. However, all Maryland Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsurance, the plan picks up the tab for the remainder of the year.
- If you want prescription coverage and have Original Medicare you must purchase a Medicare Part D plan. However, most Medicare Advantage plans include a Maryland Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
- In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system deductibles and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
Medicare Supplements vs. Medicare Advantage
We're frequently asked:
- 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 just a minute to dispel any misconception that these plans are bad or might have serious disadvantages.
Why Maryland 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 Maryland 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?
A good way to figure out which coverage is best for you is to look at your health and your finances. If you have one or more chronic conditions and you can afford a supplement, traditional Medicare is likely the best option because you have the ability to choose your doctors. Conversely, if you are super healthy, or you are unable to afford a Medicare supplement, then Medicare Advantage is a viable option.
Here's the fundamental truth. Medicare plus a Medigap plan works best for people with chronic health conditions. It's also the best coverage for people who can afford a higher monthly premium, even if they rarely see a doctor.
Are There Disadvantages to Joining a Medicare Advantage Plan in Maryland?
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are like apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay.
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 Maryland, 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 Maryland Medicare Advantage Plans
Medicare Advantage plans vary from County to County in Maryland. 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.
One of the best features of Maryland Medicare Advantage plans is the extra benefits, including prescription drug coverage. Most plans include Part D, but not all. You can quickly see with plans offer it in your area by entering your zip code in this tool.
While not for everyone, Medicare Advantage plans have their benefits. The best way to understand these plans is to evaluate your health and financial situation. Here is an article that will help you make the right choice.