Open enrollment for Medicare Advantage Plans will run from January 1, 2024 to March 31, 2024, giving members the option to switch plans or move back to Original Medicare.
Understanding Medicare Advantage Plans
Medicare Advantage Plans, sometimes known as “Part C” or “MA Plans,” are offered by private companies approved by Medicare. The two most popular Medicare Advantage Plans are Health Maintenance Organization (HMO) Plans and Preferred Provider Organization (PPO) Plans.
Differences Between Medicare Advantage and Original Medicare
Whereas Medicare Advantage Plans typically have networks of providers based in a specific geographic area, Original Medicare allows you to choose any provider in the United States who accepts Medicare. Outside of emergencies, HMO plans typically require that you go to in-network doctors, health care providers, or hospitals. In PPO Plans, you may be able to receive care from providers outside of the plan’s network for a higher co-pay.
To receive full coverage, Original Medicare requires being enrolled in four separate plans: Part A, Part B, Part D, and Medigap. Part A covers hospitalizations, Part B covers doctor visits and outpatient services, Part D covers prescription drug plans, and Medigap helps pay for deductibles and copayments. Conversely, Medicare Advantage Plans combine Parts A and B of Original Medicare into one plan. Additionally, most Medicare Advantage plans cover prescription drugs. However, if you select a Medicare Advantage Plan, you cannot also purchase a Medigap policy.
Another pertinent difference between Medicare Advantage plans and Original Medicare is cost. For example, for Parts A, B and D of Original Medicare, the federal government sets the premium, deductible and coinsurance amounts. Most people do not pay a premium for Part A hospitalizations. However, they must pay a $1,632 deductible for each benefit period used in 2024, in addition to daily copayments for extended hospital stays. For Part B premiums, most people will pay $174.70 per month, an annual deductible of $240.00, as well as 20% of the cost of doctor visits, lab testing, and other outpatient services. Part D deductibles cannot be greater than $545.00, with premiums and cost sharing varying by plan. Medigap supplemental policies are sold by private insurers, with varying premiums as well.
Enrollees of Medicare Advantage Plans must pay the Part B premium of $174.70 per month, as well as any Part A premiums if ineligible for free coverage. Enrollees may be also responsible for separate Medicare Advantage premiums, as well as copayments for hospital stays and/or certain Part B services. Medicare Advantage Plans have an annual limit on out-of-pocket expenses, which includes deductibles and copayments. For in-network services, the limit is currently $8,850.
Choosing the Right Plan
Selecting a Medicare Advantage Plan requires consideration of your individual needs. If you travel or spend part of the year out of state, it’s important to ensure your Medicare Advantage Plan offers an extended network or travel benefit. Additionally, if you had a health event or anticipate a procedure in the immediate future and prefer specific care providers, specialists, or hospitals, confirm they are in your Plan’s network. If you require prescription medication, consider their cost relative to each plan. If you require specific medication, you can also input the name of the medication into the plan finder on Medicare.gov to which plans offer coverage.
Open Enrollment Resources
For more information regarding Medicare Advantage open enrollment, be sure to visit https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options. Our Elder Law team at Mandelbaum Barrett PC is also here to assist you in selecting the Plan that is right for you.