My mother has a Medicare Advantage plan and is considered low-income. So this article is written with personal knowledge, not just professional experience.
One of the most significant benefits of Medicare Advantage is that it can be particularly helpful for those who are on a limited income. That’s because it often includes additional services and benefits not available with Original Medicare. And those services would also not be included in a Medigap plan. In addition, many MA plans have lower out-of-pocket costs, which can be crucial for people on a fixed income.
The purpose of this guide is to help you understand what Medicare Advantage is and how it works. Also, why it might be a good option for you who are considered a low-income beneficiary. So whether you’re already on Medicare and looking to switch plans or just starting to explore your options. I hope this guide will be a helpful resource for you. Let’s dive in!
Medicare Advantage Eligibility
To enroll in a Medicare Advantage plan, you must meet certain qualifications. The following are the requirements:
- You must be enrolled in Original Medicare. If you’re not already enrolled in Original Medicare, you’ll need to do before you can enroll in a MA plan.
- You must reside in the Medicare Advantage plan’s service area to qualify.
- Each plan has a specific region it serves, so it’s essential to ensure you’re in the right area before enrolling.
Now, let’s talk about special eligibility requirements for low-income individuals. If you meet certain income and asset thresholds, you may qualify for a Medicare Advantage plan with additional benefits and lower costs. This is called the Medicare Advantage Special Needs Plan (SNP).
There are three types of SNPs:
- Dual Eligible SNP: For those who are eligible for both Medicare and Medicaid
- Chronic Condition SNP: Individuals who have particular persistent illnesses, such as diabetes or congestive heart failure.
- Institutional SNP: For those who live in a nursing home or other long-term care facility
So, here’s the deal with Medicare Advantage and income limits. Basically, there aren’t any income limits to join. However, happen to qualify for a low-income subsidy or Medicaid. You might be able to find a Special Needs Plan in your area that’s designed for those with lower incomes.
Wesley Evans
Additionally, to qualify for an SNP, you must meet the eligibility requirements for that specific plan.
For example, to enroll in a Dual Eligible SNP, you must be eligible for Medicare and Medicaid. Also, your income and asset levels must be within certain limits.
It’s worth noting that even if you don’t qualify for an SNP, many Medicare Advantage plans offer benefits and cost savings. That means you can still be beneficial to low-income individuals. So, if you’re on a tight budget, explore your options and find a plan that fits your needs and budget.
Benefits of Medicare Advantage Plans
As you may know, Medicare Advantage (Medicare Part C) is an alternative to Original Medicare. Additionally, it offers a wide range of benefits that you may or may not be aware of.
Some common benefits offered to members of Medicare Advantage plans are:
Now, if you’re a low-income individual, you may be eligible for additional benefits through a Medicare Advantage plan. These benefits include the following:
- reduced copays and deductibles
- transportation to medical appointments
- home-delivered meals
- flex cards to help pay for groceries or utilities
- a larger over-the-counter, and home health care.
These additional benefits can really make a difference in the lives of low-income seniors who may struggle to make ends meet.
Here’s a video on how Medicare Advantage plans compare to Original Medicare.
Costs
It’s important to understand how much you’ll be paying for your healthcare, so you can make informed decisions about your coverage.
Most plans will have a monthly premium, which is the amount you pay each month to have the plan. In addition to the premium, you’ll also have to pay copays, deductibles, and coinsurance when you receive healthcare services.
Now, if you’re a low-income individual, there are ways to reduce your Medicare Advantage costs. You may be eligible for Extra Help, which is a program that helps pay for your prescription drug costs. You can also look into Medicare Savings Programs, which can help pay for your premiums and other costs.
Enrollment Periods
If you’re considered dually eligible, you have the entire year pretty much to change or enroll in a MA plan. Of course, there are rules, and your local broker should assist in going over those with you, but when you are considered low-income, life is hard enough, and more options are available in regard to your healthcare choices as far as Medicare Advantage is concerned.
Watch these 2 videos to get a visual idea of what I am writing about.
Wesley Evans
- Annual Enrollment Period (AEP) is from October 15th to December 7th each year. During this time, you can enroll in a Medicare Advantage plan or switch from one plan to another.
- If you miss the AEP, you may still be able to enroll during the Medicare Advantage Open Enrollment Period, which runs from January 1st to March 31st. However, during this time, you can only switch from one Medicare Advantage plan to another or switch back to Original Medicare.
- If you’re a low-income individual, you may qualify for additional enrollment options. These are known as Special Enrollment Periods or SEPs. See my video above for an in-depth look into SEPs.
Choosing a Plan for Low-income Individuals
If you’re new to Medicare or just looking to switch up your coverage, it’s important to know your options when it comes to Medicare Advantage plans. There are a few different types of plans to choose from, each with its own benefits and limitations.
There are four main types:
- Health Maintenance Organization (HMO) plans: typically have lower out-of-pocket costs and require you to stay within a network of healthcare providers.
- Preferred Provider Organization (PPO) plans: offer more flexibility in choosing healthcare providers but may come with higher costs.
- Private Fee-for-Service (PFFS) plans: allow you to see any Medicare-approved healthcare provider who agrees to the plan’s payment terms, but they can be more restrictive in terms of coverage.
- Special Needs Plans (SNPs): designed for those with specific health conditions or circumstances, such as those with chronic illnesses or who live in a nursing home.
Common Concerns
While Medicare Advantage plans offer comprehensive coverage, they may have some limitations on the types of healthcare services and providers covered. For example, some plans may not cover certain prescription drugs or medical procedures and may require you to seek care within a specific network of providers. It’s important to review the plan’s coverage and network before enrolling to ensure that your healthcare needs are adequately covered.
Next, if you’re eligible for both Medicare and Medicaid, you may be concerned about how enrolling in a Medicare Advantage plan will affect your Medicaid benefits. While Medicaid benefits are not typically affected by enrolling in a Medicare Advantage plan, it’s important to check with your state Medicaid agency to ensure that you’re still eligible for Medicaid and that your benefits won’t be impacted.
Finally, Medicare Advantage plans typically have provider networks, which means that you’ll need to seek care from healthcare providers that are in your plan’s network. Many beneficiaries that qualify for the Special Needs Plans are part of a managed care system. Where you see a primary doctor first, who refers you to specialists, and you have an assigned care specialist to check up and in on you often.
My Final Thoughts
Making healthcare decisions can be confusing, but it’s important to ask questions, do your research, and fully understand your plan and its benefits. Unfortunately, many people simply trust their insurance professional to guide them toward the best plan, but that isn’t always the case.
As someone who works primarily with low-income individuals in Los Angeles County, I know firsthand that many licensed professionals only focus on Medicare Supplement plans, which may not be affordable for those with limited financial means. This is why I choose to assist low-income individuals, as I understand that they often don’t have the option to choose a Medigap plan due to financial constraints. It’s both a professional and personal choice for me to help those who need it most.
Meeting with the right insurance professional can be crucial for low-income individuals to ensure they are taking advantage of all the best offerings available to them through their special needs plan. With the proper guidance, you can access additional benefits such as dental, vision, or hearing coverage, transportation assistance, and more. These extra benefits can make a significant difference in the lives of low-income individuals who may be struggling to afford necessary healthcare services.
If you’re feeling overwhelmed or have more questions about Medicare, don’t hesitate to schedule a phone call with a local broker. Southern CA residents can schedule with me.
Make sure to follow me on social to see my video content about this confusing industry.
