Medicare Advantage Plans – Pros and Cons

Specific health problems can make choosing Original Medicare or Medicare Advantage coverage a better choice for a particular person. Therefore, it is essential to understand the coverage and cost differences between them. More than 34 percent of Medicare enrollees in 2018 were covered by Medicare Advantage – and 43 percent were Florida residents (per the Kaiser Family Foundation).

The following describes three areas for consideration in determining whether Original Medicare or Medicare’s Plan C (Medicare Advantage) will be a better “fit” for your overall needs.

Hearing Loss, Hearing Aids, and Your Medicare Coverage Choices

Functioning in the workplace can be hindered by hearing loss (especially in jobs requiring in-person customer or client interactions). One-fourth of all people aged 65 and older in the US have hearing loss, per the National Institute on Deafness and Other Communication Disorders [NIDCD]).

Besides interfering with workplace functioning, hearing loss can also limit enjoyment of social interactions (e.g., family celebrations). In turn, isolated older-aged people are more likely to develop dementia.

Part B of Original Medicare covers a hearing test only if ordered by your physician to determine a course of treatment (and Original Medicare does not cover routine hearing exams or hearing aids).

However, a Medicare Advantage plan may cover hearing exams and hearing aids depending upon the plan. While the average price of a digital hearing aid is $1,500, the cost for a more technologically-advanced hearing aid can be three-fold higher. The following are the most commonly-worn types of hearing aids in the US (as described by the Mayo Clinic):

• Behind the Ear (BTE) – hooks over top of ear and rests behind ear;
• Receiver in canal or receiver in the ear;
• Open fit (recommended for mild-to-moderate hearing loss only)

Crowns, Implants, and Dentures – Will Medicare Cover the Costs?

Dentist and dental hygienist services are not covered by Original Medicare (but may be covered by a Medicare Advantage plan). Since one in five Medicare beneficiaries spent more than $1,000 on dental care in 2016 alone, purchasing dental insurance may make sense if you know that your teeth are not in excellent condition.

Foregoing routine dental care solely due to cost can lead to preventable tooth loss, necessitating even more expensive dental care. Medicare supplemental insurance (termed Medigap) does not usually cover dental services, but some membership associations do offer group dental insurance policies.

If you are still employed – and your employer offers dental insurance – it may make sense for you to enroll in that insurance prior to becoming a Medicare beneficiary. Medicaid in Florida reimburses for “medically necessary” dental services for covered individuals living in poverty (per the Florida Agency for Health Care Administration).

Your Life Savings and Medicare Costs

Anyone enrolled in a Medicare Advantage plan still needs to pay for Part B of Original Medicare. Moreover, a Medicare Advantage enrollee cannot be covered by a Medigap plan (as Medigap only supplements Original Medicare coverage) – so there is no need to purchase a Medigap policy if you have Medicare Advantage coverage.

According to the Centers for Medicare and Medicaid Services (CMS), the following are four different types of Medicare Advantage plans:

1. Health Maintenance Organization (HMO) plans – limiting acquisition of healthcare services to only “in-network” providers.
2. Preferred Provider Organization (PPO) plans – offering a higher percentage of coverage for “in-network” providers than the utilization of “out-of-network” providers.
3. Private Fee-for-Service (PFFS) plans – similar to Original Medicare in enabling utilization of any provider or hospital (as long as the specific PFFS plan is accepted).
4. Special Needs Plans (SNPs) – specialized plans targeted at specific groups of people (e.g., people with specific chronic diseases such as diabetes).

Since there are many potential monthly costs to consider (besides deductibles and “out-of-pocket” cost-sharing), it is crucial to purchase the plan that will best meet your unique health needs.

Likewise, it is also crucial to understand your own financial constraints to purchase no more insurance coverage than you really need. UrHealth Benefits wants you to obtain the Medicare coverage that is right for your needs, and we are available to assist you in understanding your options.

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