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  • Cameron Oglesby

Your Medicare Advantage Plan may have a built-in disadvantage.


As the name implies, Medicare Advantage Plans come with many advantages, starting with annual out-of-pocket cost caps. Those advantages include dental, vision and Part D drug coverage, and even free health club memberships. That’s why last year 42% of Medicare beneficiaries enrolled in one.


But if you do a lot of traveling, are a snowbird, or split your time between two homes, they have one disadvantage compared to Original Medicare.


That disadvantage is geographical.


Original Medicare’s coverage area extends throughout the entire United States. So if you need a doctor or hospital while away from home, all you need do is find one that accepts both Medicare payments and new patients. You’ll also need to pay out-of-pocket costs, which is why more than eight out of ten beneficiaries also have some sort of Medigap insurance. Since 2006, Medigap plans have not included Part D coverage, so whether at home or away, you’d need to buy Part D coverage for your prescription meds.


Advantage Plans are HMOs or PPOs with their own provider networks. So all you pay for medical care is a comparatively nominal in-network copayment. But even with plans from national insurers, you may find that the coverage area is anything but national. Some networks may be strictly local or regional. Some may cover you in half a dozen or so states. Some, for their snowbird members, have networks in Florida. So if you’re planning to hit the road a lot, you need to check the size and extent of your plan’s provider network.


Part D coverage is usually no problem, because many Advantage Plans’ networks include national pharmacy chains, so you can pick up prescriptions and refills almost anywhere.


But that’s not the case with medical care. The typical Advantage Plan will cover visits to urgent care practices and to hospital emergency rooms. That takes care of both ends of the spectrum, but what about the middle? For example, what if you need a dentist? Or what if an urgent care doctor you visit says you need a specialist?


Whether you’re a snowbird, a road warrior, or strictly a homebody, you need to choose your Medicare coverage accordingly; one size doesn’t fit all.


The same is true for senior care in general. That’s why our guiding principle is that no two people are identical; that every individual client is different, each with different health, mental, and social needs and priorities.


So when you contact us, the very first part of our holistic senior care management planning is a thorough three-part needs assessment in which we ascertain not only our clients’ and their families’ physical, emotional and environmental needs, but their values and priorities as well. What we learn becomes the basis of a custom-tailored, coordinated plan that helps you follow the route of your choosing as you continue your journey through life.


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