Medicare Advantage in 2020

If you are turning 65 soon, will be eligible for Medicare due to a disability, you may be considering Medicare Advantage. There are approximately 24 million people currently enrolled in a Medicare Advantage plan. In 2020, changes have been made to include lower costs, more benefit options, and benefits that are suited to the needs of Medicare recipients.

If you have been wondering if a Medicare Advantage plan could be the solution to your healthcare coverage needs, let’s get you up-to-date with the information you’ll need before making a decision.

What is Medicare Advantage?

Medicare Advantage (MA) plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. They are required to provide the same benefits as Original Medicare Part A and Part B, but most MA plans offer additional benefits at little to no extra cost.

Additional benefits offered by MA plans may include vision and dental care, fitness club memberships, hearing exams, and prescription drug coverage. The Centers for Medicare & Medicaid Services (CMS) provides oversight to make sure all plans provide the appropriate benefits and protections to consumers, but costs and coverage can vary.

Who is eligible for Medicare Advantage?

To qualify for enrollment in a Medicare Advantage plan in 2020, you must meet the following requirements:

• You must be eligible for and have already enrolled in Original Medicare Part A (hospital insurance) and Part B (medical insurance). To qualify for Medicare Part A and Part B, you must be 65 years old, have been receiving Social Security or Railroad Retirement disability benefits for 24 months, or have been diagnosed with certain illnesses, such as ALS.
• You must be a resident in the region of service covered by your Medicare Advantage provider. This is the region where the provider is licensed to provide coverage.
• Even if you have a Medicare Advantage plan, you are still responsible for paying your Part B monthly premium.

Many people who are diagnosed with ESRD (end-stage renal disease) get healthcare coverage through Original Medicare Part A and Part B, but you may be able to enroll in a Medicare Advantage Special Needs Plan (SNP). Special Needs Plans limit membership to people with specific chronic conditions or circumstances. You may be able to enroll in a SNP that supports the healthcare needs of ESRD patients. If you were already enrolled in a Medicare Advantage plan when you were diagnose with ESRD, you can remain with the plan.

What types of Medicare Advantage programs are available in 2020?

There are different types of Medicare Advantage plans that may be available in your area. Let’s review the most common MA options.

Health Maintenance Organizations (HMOs) usually require you to get services from healthcare providers in the plan’s network. You will also need to choose a primary care doctor , and will need to see that doctor in order to get a referral to see a specialist. The exceptions to this rule include:

• Emergency care
• Urgent care provided outside the network
• Kidney dialysis provided outside the network

HMO-Point of Service plans allow certain services to be provided outside the network but at a higher cost. This option allows more flexibility for members to get care outside the HMO’s network for certain treatment under certain circumstances.

Most HMOs also include prescription drug coverage (Part D) plans, but make sure you discuss the details of Part D coverage before signing up.

Before signing up for an HMO, consider the following:

• You be notified if your primary care doctor or any other health care providers you see leave the plan, giving you the option to choose other physicians in the plan’s network.
• You may be required to pay the full cost of healthcare you receive outside the plan’s network.
• You must adhere to rules such as getting approval for certain services beforehand.

Preferred Provider Organization (PPO) plans provide beneficiaries with a network of doctors, health care providers, and hospitals to use for their healthcare at a lower cost. If you go outside the network, you pay more. You are not required to choose a primary physician and can use any of the specialists on the plan’s list. If you choose to use a provider not included on the plan’s list, you will pay more. Prescription drug coverage is covered by most PPOs, but you should discuss the details before signing up.

A Private Fee-for-Service Plan (PFFS) will determine how much you will pay for care you get from doctors and other health care providers and hospitals. Depending on the plan, you may be able to use any doctor, health care provider, or hospital for your care or you may have to use providers within a plan’s network. Most PFFS plans cover prescription drugs, but check with your plan before signing up for the details. It’s important to note the following about PFFS plans:

• You will be treated by providers within the PFFS plan’s network even if you have never gone to them before.
• You may be rejected by health care providers who are not in the PFFS plan’s network even if you have gone to them before.
• Before receiving the services of health care providers or hospitals, you will need to make sure they agree to treat you according to your plan’s terms of service and payment.
• Doctors, health care providers, and hospitals must treat you in emergencies.
• You are required to use your PFFS plan’s membership card for every healthcare situation.
• You are required to pay the copayment or coinsurance at the time you get the service.

A Medical Savings Account (MSA) Plan is a consumer-directed Medicare Advantage plan.  
MSA plans have two parts:

• A high-deductible health plan that begins coverage when you meet your yearly deductible. This amount depends on which plan you choose.
• Money is deposited into your account. You can use this money for healthcare before meeting the deductible.

MSA plans cover all Medicare services that any Medicare Advantage plan must cover, with additional benefits at an additional cost. Some plans have options for dental, vision, and long-term care not included in Original Medicare.

Because MSA plans do not include Medicare Part D prescription drug coverage, if you wish to have this benefit you must enroll in a Medicare Part D plan in addition to your MSA plan.

What do Medicare Advantage policies cover in 2020?

All Medicare Advantage policies are required by federal law to at least provide all the services that Original Medicare Parts A (hospital insurance) and Part B (medical insurance) provide. If you are enrolled in a Medicare Advantage plan, coverage for hospice care, certain Medicare benefits, and some costs for clinical research are still covered by Original Medicare.

Medicare Advantage policies cover any emergency or urgent care even if it takes place outside the plan’s network. Your Medicare Advantage plan may or may not choose to cover services that Medicare does not consider as medically necessary. You must discuss the details with your provider.

Most Medicare Advantage plans also include coverage for additional benefits that are not included in Original Medicare Parts A and B. These benefits may include:

• Vision care, and in some instances eyeglasses and contact lenses
• Hearing exams and hearing aids
• Dental care and dentures for some beneficiaries
• Fitness program memberships
• Transportation to health care visits
• Certain over-the-counter drugs
• Adult day-care services
• Chiropractor services
• Other wellness and special health care services

Most Medicare Advantage policies also include prescription drug coverage (Medicare Part D). If prescription drug coverage is particularly important to you, make sure your current prescription drugs are included in the plan’s drug formulary, or list of covered drugs, and checks your costs.

Even if you have a Medicare Advantage plan and pay a monthly premium for it, you must continue to pay your Original Medicare Part B premium. As of 2020, the standard Part B premium is $144.60. People who have a higher income may have a higher premium. The amount you pay for your Medicare Advantage monthly premium depends on the company providing it, what extra benefits are included, and where you live.

When can you enroll in a Medicare Advantage plan in 2020?

You can enroll in a Medicare Advantage plan during the following enrollment periods:

• Your Medicare Initial Enrollment Period (IEP) which is a seven-month period that begins three months before your 65th birth month, last during your birth month, and ends three months after your 65th birth month.
• A Special Enrollment Period (SEP) if you qualify due to certain life events.
• The Medicare Advantage Open Enrollment Period, from January 1 to March 31.
• If you are enrolled in Part A but are new to Part B, you can enroll in a Medicare Advantage plan during the Part B General Enrollment Period from April 1 through June 30.
• The Annual Enrollment Period, which runs from October 15 to December 7 every year. During this period you can change your Medicare coverage, choose a new Medicare Advantage plan, or switch from Original Medicare to Medicare Advantage. During this period you can also change your Part D plan.

If you are considering enrolling in a Medicare Advantage plan in 2020, take the time to review your options.  Make a list of questions you have and get them answered by a licensed and knowledgeable sales agent before you enroll. A Part C Medicare Advantage plan is a great option for millions of Americans. It may be worth the time and effort to research and compare your options to find the plan that’s right for you.