Medicare Advantage in 2021 – What You Need to Know

Though age is just a number, turning 65 can be a different experience altogether. Many things in life start changing even before you actually hit this critical milestone. More than anything else, healthcare expenses are at the top of the mind. And, being a resident of the US, the first thought that flashes through the mind is Medicare enrollment. It’s my personal experience that a majority of people look for traditional Medicare plans, Medicare Supplement, and Prescription Drug plan. They are clueless about the benefits of the Medicare Advantage Plan. In this article, I’ll explain why this is the best choice over original Medicare plans in 2021 and I’m confident that, by the time you finish reading this post, you’ll have complete clarity on the subject.

First things first, the difference is similar to ordering a pre-fixed meal at a restaurant where the menu is already selected (Medicare Advantage by private insurers) or choosing a buffet (original Medicare provided by the federal government) that allows you to select food items of your choice. The Medicare Advantage plan is designed as an all-in-one bundle, including hospital care (Part A), doctor’s consultancy (Part B), and prescription drugs (Part D). Here, it is to be noted that, unlike original Medicare plans, the Medicare Advantage plans have a lower out-of-pocket maximum limit.

After the latest announcement of the Trump government , premiums for the Medicare Advantage plan have come down 14 percent in Texas from what they were during 2017-20( Source: cms.gov) while the plan choices, benefits, and enrollment features are more now. Some of the salient features of the Medicare Advantage plan in 2021 includes the following:

• Those opting for the Medicare Advantage plan have 2,100 more plan choices than what they had in 2017 and now they can choose from a total 4,800 plans.
• Hospital insurance (Part A)covers in-patient hospital visits and some other hospital expenses such as short-term nursing facility care and home healthcare visits.
• Medical insurance (Part B) includes expenses pertaining to preventive and diagnostic services. Many plans also cover medical transportation costs.
• A large majority of Medicare Advantage plans have automatic prescription drug coverage which is not the case with the original MA plan.
• Almost one-third of Medicare Advantage plans are offering supplemental benefits related to the COVID-19 pandemic in 2021. Now you can avail extra care/relief packages, cost-sharing for COVID-19 treatment, and you can even claim compensation for PPE kits. And, most importantly, CMS (Centres for Medicare & Medicaid Services) has made it mandatory for private insurers to cover the out-of-the-pocket cost of the COVID 19 vaccine. This is a big advantage of the Medicare Advantage plans in 2021.
• Healthcare expenses like vision, hearing, dental, and prescriptions are not included in the traditional Medicare plan; however, Medicare Advantage plans include such minor medical benefits.
• Prescription drug coverage (Part D) is normally not offered under traditional Medicare, though this is part of all Medicare Advantage plans.

A simple rule of thumb is that the less premium you pay, the more you will have to pay for other expenses. The cost of a Medicare Advantage plan depends on various factors such as when you decide to opt for the service or which type of services you go for etc.

• Based on your choice of HMO or PPO, your monthly premium can be zero.
• In order to buy a Medicare Advantage plan (Medicare Part C), you have to mandatorily pay the Medicare Part B premium. If you’re eligible for the federal retirement benefits, you’re automatically enrolled in the Medicare plan and then, you can shop for a Medicare Part C plan.
• Copay: It is the flat fee that you pay whenever you receive certain medical services, such as a hospital stay for surgery that can be availed by paying $100 per day.
• Deductible: This fee is required to be paid out-of-pocket until you reach the deductible limit. After this limit, your Medicare Advantage plan can cover some medical costs.
• Out-of-Pocket Limit: This varies according to the type of services you receive and whether you choose to avail the service from an in-network or out-of-network healthcare provider.

Though some Medicare Advantage plans may seem costly because of inclusion of out-of-pocket costs, it can actually help you save more in the long-term. What I suggest people is to consider their medical needs carefully before going shopping for a Medicare Advantage plan. For those who are receiving employer-sponsored coverage, Medicare Advantagemay not be necessary for them.

If you seek assistance for choosing the right Medicare Advantage Plan, feel free to contact our office at 210-908-6565, and we’ll be happy to assist you.