How Does Medicare Advantage with Medicaid Save You Money?

By Nidhi

Both Medicare and Medicaid are two essential healthcare programs in the United States. They provide critical services to millions of Americans every year, primarily those who are elderly or disabled. For many people, Medicare and Medicaid are the only guaranteed sources of health coverage. A third, Medicare Advantage, provides benefits from the original Medicare program through private insurance companies.

Do you wonder if it's possible to get a combined plan that combines these two benefit plans for your healthcare needs at one time? The answer is yes! Let us see how you can get the best of both and how getting Medicare Advantage with Medicaid will save you money on your monthly premium expenses and other out-of-pocket costs.

What is Medicare Advantage?

Medicare Advantage is a type of Medicare coverage that allows a person to have a single plan that covers all their medical benefits from one source. Medicare Advantage plans are private plans approved by Medicare to provide coverage to Medicare beneficiaries. These Medicare Advantage plans are also called Medicare Part C plans since private insurance companies administer them. This is different from the traditional Medicare program administered by the government. 

People who are on Medicare can choose to enroll in Medicare Advantage Plans. However, they must also be on Medicaid to enroll in these plans. This is because people on Medicaid are generally low-income and don't have the financial means to cover their out-of-pocket medical costs. These costs are separate from the monthly premium and other fees that you pay for your healthcare coverage. Medicare Advantage plans are the solution for these financial burdens.

Understanding the Difference Between Medicare and

Medicaid

Before going any further, let's understand the differences between Medicare and Medicaid. 

 - Eligibility: One of the significant differences between Medicare and Medicaid is their eligibility requirements. Medicare is primarily for people over 65, those with a disability, and those with a recent organ transplant. Alternatively, Medicaid is primarily for low-income individuals who are also pregnant, disabled, or elderly.

 - Premiums: Another difference is that Medicare charges monthly premiums, and Medicaid does not. In this sense, Medicare is more like an insurance program that pays you monthly benefits if you get sick or injured. Medicaid is more like a health subsidy program that helps you with your out-of-pocket expenses. 

- Access to Doctors and Hospitals: Another significant difference between Medicare and Medicaid is that Medicare doesn't limit people to specific doctors or hospitals. On the other hand, Medicaid programs do have strict limitations on which doctors and hospitals you can use.

Benefits of Getting Medicare Advantage with Medicaid

- You will get more coverage: One of the biggest reasons people get a combined plan is because they want more coverage. Medicare Advantage plans often provide more coverage than traditional Medicare plans. 

- You will have lower monthly premiums: Another way that getting a combined plan will save you money is through lower monthly premiums. Medicare Advantage plans charge a lower monthly premium if you use both Medicare and Medicaid as your payment source. 

- You will have fewer out-of-pocket expenses: Medicare Advantage plans will also provide you with fewer out-of-pocket expenses. This means you will have less to pay for each month and throughout your healthcare coverage. 

- You will avoid the Medicare Part D Donut Hole: Finally, you will also prevent the dreaded Medicare Part D Donut Hole if you have both Medicare and Medicaid as your coverage sources. Part D Donut Hole implies that you must pay all prescription charges out of pocket up to a yearly maximum. It is a coverage gap. 

How To Enroll in Medicare Advantage Through Medicaid?

Establish Eligibility

Generally, you can be eligible for Medicare if you are 65 or older. People below 65 years of age with specific impairments and those with End Stage Renal Disease are also eligible. To determine your eligibility, go to The Official United States Government Site for Medicare.

Enroll during the Open Enrollment Period

You must enroll in Medicare Advantage during the open enrollment period, which runs from October 15 to December 7. You can pick your first Medicare or Medicare Advantage program at this time or move from original Medicare to Medicare Advantage. You can also go from Medicare Advantage to traditional Medicare.

You can transfer from one Medicare Advantage plan to another during the open enrollment, which runs from January 1 to March 31. Additionally, you may switch back to the original Medicare at any point throughout this period.

Choose the Best Plan

While approximately one-third of Medicare beneficiaries pick a Medicare Advantage plan, Medicare Advantage is not appropriate for everyone. It's necessary to properly evaluate plan papers. Make sure you understand the many types of Medicare Advantage plans, which are:

Plans for Health Maintenance Organizations (HMOs): Important facts about the plan:

• Most HMOs include medication coverage, but some don't.
• Generally speaking, picking a primary care physician is a need (PCP). If you still have medical concerns after seeing your primary care physician, you will be referred to a specialist.
• After the deductible is met, the plan often does not pay for services outside the network providers provide. 
• You might still be covered for emergency situations or medical attention received outside the HMO's service region.
• Even while HMOs pay for a wide variety of medical care, you still need to understand and adhere to the plan's guidelines to receive full benefits.

Plans under the Preferred Provider Organization (PPO): Some facts about PPO include: 

• Although you have the freedom to see any doctor who takes Medicare, you should be aware that going to an out-of-network specialist might result in much greater out-of-pocket expenses.
• Prescription medicines are often covered under Medicare Advantage PPO plans.
• If you enroll in one of these Medicare plans, you won't need to select a primary care physician (PCP) and won't frequently require a referral to see a specialist.
• Numerous services that aren't included in basic Medicare could be reimbursed, albeit the associated costs might be higher.

Private Fee-for-Service (PFFS) arrangements: A few things to keep in mind are:

• Quite a bit of variation exists between the various strategies. Some provide substantial savings through a network of recommended doctors and hospitals, while others offer the freedom to pick a service provider.
• Access to any Medicare-approved service or product is guaranteed, while the final bill may vary according to your specific Medicare Advantage plan's guidelines.
• Prescription medicines are often included in PFFS plans' coverage.
• You can see a specialist without first deciding on a primary care physician (PCP) or getting a referral.
• A doctor or hospital has to be on board with the plan before they can treat you or take your insurance. A doctor who has previously examined you may decide not to treat you.

Plans for People with special needs (SNPs): Special Needs Plan include: 

• Prescription medicines are covered by SNPs.
• Option to choose a PCP and obtain a referral to see a specialist.
• SNP plans provide specialized care for the sickness or symptoms covered by the plan.
• Some plans are exclusively available to those who reside in institutions, such as Mental healthcare centers.
• The availability of certain Medicare Advantage coverage is heavily influenced by your geographic location. You may utilize The Official U.S. Government Site for Medicare to find out which programs are available to you and to learn more about plan alternatives to discover which one could be best for you.

Make certain you can answer the following questions concerning your future plans:

• What is the maximum out-of-pocket expense?
• What are the premiums?
• Are prescription medications covered?
• What services does the package include?
• Is my doctor on the plan?
• Is there any extra information regarding the plan available online?
• Is there anyone I know who has this plan? Do they enjoy it?
• Which structure of strategy is best for me?

It may also be helpful to add up your current plan's yearly medical expenditures and compare them to forecasts for your future Medicare Advantage plan—based on all of the above questions and the specifics of the plan's coverage.

Conclusion

So, as you can see, if you are covered with Medicaid, adding a medicare advantage will only be more beneficial, cost-effective, and sustainable in your future. Keep yourself updated with more such information on Insuranceandleisure.com.