What is a Pennsylvania Medicare Advantage Plan?
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 Pennsylvania.
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 Pennsylvania. 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 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. Pennsylvania 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 Pennsylvania 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 Pennsylvania 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 Pennsylvania 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 Pennsylvania 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.
Medigap vs. Medicare Advantage
Three of the most common questions we get are:
- 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 answer these three questions right now.
Why Pennsylvania Medicare Advantage Plans are Bad
People that claim Medicare Advantage plans are bad simply misunderstand what they are and how they work. Over 20 percent of all Medicare beneficiaries in the state of Pennsylvania choose Medicare Advantage and like the care they get. However, these plans are not suitable for everyone.
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.
What are the Disadvantages of Pennsylvania 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.
With Medicare Advantage you pay a little each month (with some plans you pay nothing). This is the monthly premium. But you also pay a copay when you use most medical services, and they add up fast. However, with traditional Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.
When Should I Consider Medigap Instead of Medicare Advantage?
- 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 Pennsylvania Medicare Advantage Plans
The best way to get the correct answer is to enter your zipcode in this Pennsylvania Medicare Advantage plan tool. Unlike Medicare Supplements, Advantage plans are different in each county..
One of the best features of Pennsylvania 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.
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.