The Current Situation
As we are deep in the throes of Medicare enrollment season, we've had countless calls from new and existing clients in a panic over their coverage. Concerns range from “will I lose my coverage, if I don’t renew?” to “I just got a notification that my premium tripled for next year!” The most disturbing theme amongst all these calls is the painful amount of misinformation that is being fed to beneficiaries as a way to either scare or entice them into switching plans. You’re not being fed a public service announcement – it's sales & marketing!
Common Misconceptions Debunked
Myth #1: If you enroll in a Medicare Advantage (MA) plan, the minute you’re admitted to the hospital, it's an automatic $9000. (This misinformation came from a local news report. The best I can surmise is that the person being interviewed was a broker making a misleading statement about maximum out of pocket (MOOP) costs.)
FACT: Medicare Advantage plans are required to implement a Max Out of Pocket (MOOP) on each and every plan. The MOOP is the most a person will pay for services in a year. Once a person reaches their MOOP, they are not responsible for cost-sharing on covered services for the rest of the year.
In plainer language, this is a guarantee that no matter what happens over the course of the year, you will never be liable for more than that set in stone amount. You could have five surgeries and stay in the hospital for a month and you’d still only be facing the Max Out of Pocket set by your plan. That’s a great protection.
The MOOP is your maximum liability for the entire year
Once reached, you pay nothing for covered services for the rest of the year
Many MA plans offer MOOPs much lower than federal limits (often $3,000-$4,000)
This protection applies regardless of how many hospitalizations or procedures you need
Note: While some Medigap or Supplement plans (specifically two) include out-of-pocket maximums, most don't offer this feature.
Myth #2: Medicare Advantage Plans Are Just HMOs
FACT: This is an outdated perspective. While early Medicare Advantage plans had limited networks, today's plans offer:
Extensively developed provider networks
Coverage for out-of-network providers in most cases
Significantly more flexibility than traditional HMOs
Honestly, its an apples to oranges comparison. When Medicare Advantage plans first came on the scene, they did have limitations on who was “in network” because the carriers hadn’t contracted with a ton of providers out the gate. Over time, those networks have grown and grown and grown to where you shouldn’t feel the constraints of in or out of network.
Regardless, the vast majority of Medicare Advantage plans DO give you coverage for seeing out of network providers where types of HMO plans in question give no coverage for seeing an out of network provider.
Medicare Advantage Plan Benefits Comparison
To that end, choosing Medicare Advantage could very well offer more coverage for different types of care beyond doctor/specialist visits & hospitalizations. Think of all the different types of alternate policies you’d have to take out (and at what monthly premium) in lieu of a single Medicare Advantage plan -
*Please review all plan summary of benefit documents for clear definitions of available benefits and coverage amounts. The above represents what may be included as a covered item/service.
Making Your Decision
Remember: There's no one-size-fits-all solution. The choice between Medicare Advantage and Medicare Supplement plans should be based on your personal circumstances, including:
Your health needs
Financial situation
Preferred healthcare providers
Desired coverage features
Key Takeaway
Don't let aggressive marketing tactics or misinformation guide your decision. Instead:
Seek unbiased guidance from qualified resources
Look for advisors who:
Don't earn commissions from recommendations
Research ALL available carriers
Represent multiple insurance options
Be wary of agents who only represent a limited selection of carriers
A Tight Ship Advisor is available to help you with your Medicare coverage questions or will find you the correct unbiased resource that is best for your unique needs - info@tight-ship.com
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