Medicare Advantage Plans: Critical Wording to Understand – Hospital Coverage

Medicare Advantage plans are a great choice for medical coverage for millions of retirees today, however since these are based by geography, there may be dozens and dozens of plans to choose from.  Selecting a plan can become incredibly challenging.

Here is what we recommend that you be on the lookout for when reviewing plan documents (Summary of Benefits and Evidence of Coverage).  There is wording that is similar sounding, but drastically different in meaning. 

When looking at coverage for inpatient hospital stays (in case you happen to have to be admitted) does your plan have a copay that is a per day copayment (usually on lower premium plans) or a per stay copayment?  A cost per day and cost per stay are not the same. 

For those that can afford a little bit of premium I often recommend the lowest premium plan that has a cost per stay copayment to cover any unforeseen hospital risks.  Whether staying 1, 5, or 40 days at a hospital there would be one fixed copayment.  This is one of the major advantages of a Medicare Advantage plan.

As alluded to earlier, the Summary of Benefits for a specific plan highlights copays or coinsurance for medical services received whether in or out of network.  This Summary of Benefits section of the plan documents is simply that, a summary. 

There is a much more detailed document called an Evidence of Coverage (EOC) on which a Medicare Advantage plan is based.  These EOC documents can be up to 350-400 pages in length!!

This Evidence of Coverage describes in great detail exactly what is and isn’t covered under the specific Medicare Advantage plan.

Medicare is extremely complex and confusing!  Reach out using any of the following to see how we can of help in your specific situation:

info@superiorfinancialgrp.com
www.retirementbenefitpros.com

Photo by National Cancer Institute