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Health & Medicine

Make Medicare Advantage Plans More Appealing to Your Clients

— February 20, 2020

When it comes to purchasing Medicare coverage, there are more than a few factors to consider. The information here provides individuals with a good starting point to get the coverage they need.

Are you in charge of signing your clients up for Medicare Advantage? If so, you may find one objection to this is that they don’t fully understand what it is, what it means, or what it offers. This is where you come in like a breath of fresh air with all the information they need to make an informed decision about this insurance plan.

Medicare Advantage Can Replace Medicare Parts A and B

When it comes to the best health insurance plans, Medicare Advantage is on (or should be on) the list. It covers what Medicare Part A provides (hospital care), as well as what Medicare Part B provides (medical care).

An example would be if someone needs the flu shot. This is typically covered by Medicare Part B. However, it’s also covered by the Medicare Advantage plan. If the person’s Medicare Part A plan provides them with a covered night in the hospital, so will their Medicare Advantage plan.

There are Extra Benefits Offered with Some Medicare Advantage Plans

A huge selling point for the Medicare Advantage plan is the additional benefits it offers. Original Medicare coverage, which includes Parts A and B, provides limited coverage for any prescription drugs you are given to take at home. However, the majority of Medicare Advantage plans will provide coverage for these. They may also provide other benefits, such as routine hearing, vision, and dental benefits, along with fitness benefits.

The Plans are Regulated by Medicare

When your client chooses the Medicare Advantage plan (or if they seem hesitant to do so) let them know that while the benefits are provided by a private insurance company, they are still in the government provided Medicare program. This means they still have the protections and rights that any other Medicare recipient has, including the ability to appeal a decision regarding coverage.

There Are Out of Pocket Maximums

With original Medicare plans, there aren’t out-of-pocket maximums in some cases. However, this isn’t the case with Medicare Advantage plans. With these, there are caps on the amount that the insured party will spend out of their own pocket to cover medical expenses. Each year, the out of pocket maximum will reset.

There are Two Premiums to Pay with Medicare Advantage Plans

There are some Medicare Advantage plans that offer premiums that are $0. While this is true, there are others that require the payment of a monthly premium to receive coverage. Along with the premium paid for the Medicare Advantage coverage, individuals may also have to cover the Medicare Part B premium, which goes to the government.

Medicare Advantage Plans are Available Regardless of Most Health Problems

If a person has some type of pre-existing condition, such as cancer or high blood pressure, this isn’t going to prevent them from getting the Medicare Advantage plan.

Blood pressure cuff; image by Bru-nO, via
Blood pressure cuff; image by Bru-nO, via

However, there is one condition that may prevent access to this plan. This is true for individuals with ESRD – end stage renal disease. While this is true, those with ESRD may be eligible to enroll in another program, which is called a Special Needs Plan. This is one type of Medical Advantage plan available.

There Are Some Plans with Networks

There are some Medicare Advantage plans that have been structured as an HMO or a PPO. Each of these plans will typically have networks. These are a list of providers that have been contracted to provide their medical services under a particular plan. For an additional fee, you may also be able to use providers, hospitals, or doctors that are out of the network. Understand, though, the costs that are paid to see these out-of-network providers may not go toward the out of pocket maximum mentioned above.

When it comes to purchasing Medicare coverage, there are more than a few factors to consider. The information here provides individuals with a good starting point to get the coverage they need, and it helps you, as a seller, provide your clients with accurate information. Being informed is essential to ensure that your clients receive the coverage that meets their needs and budget. Use this information to answer any lingering questions they may have. 

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