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Medicare Advantage and Chronic Illness: What You Should Know

By Zawn Villines
The right Medicare Advantage plan can save people with chronic illnesses time and money. Medicare Advantage may also open access to new services that can improve your health.

Expenses for those with chronic and mental health conditions account for 90% of the $3.8 trillion spent yearly on heath care in the U.S., according to the Centers for Disease Control (CDC). If you have a chronic health condition, original Medicare may not cover all of your health expenses, particularly if you choose alternative or complementary care. Medicare Advantage covers more, and is often a good option for many Medicare beneficiaries with chronic diseases.

Benefits of Medicare Advantage for Chronic Conditions

Medicare Advantage plan offers private insurance through the Medicare system. The benefits are similar to original Medicare, but you may also gain access to additional services. Most Medicare Advantage plans cover dental care and prescription drugs. Many also cover services people with chronic illnesses may need, such as transportation, in-home care, complementary medicine, or nutritional supplements.

You may also be able to enroll in a Medicare Advantage special needs plan. These plans cater to people with certain disabilities, and to those living in institutional settings such as nursing homes. Special needs plans cater specifically to people with similar conditions or needs, so you may gain access to a wide range of additional services.

Special needs plans use a health maintenance organization (HMO) model. This means that you must seek care from in-network providers. The providers on the plan's panel are experts in the condition or conditions members have.

Choosing a Medicare Advantage Plan

Choosing one plan from the sea of Medicare Advantage plans can feel daunting. But the right plan can save you money, and may even help you get better healthcare. So it's worth taking some time to evaluate and compare your options. These questions can help guide your choice:

  • Which health services do I use most often?
  • Do I have medical needs that my current plan does not cover?
  • Would I like to try alternative or complementary medicine?
  • Do I need transportation or help at home?

Make a list of your needs based on these queries. When you compare plans, don't focus on which plan provides the most services. Instead, assess which plans cover the most services you actually use. Some other factors that may affect your decision include:

  • Whether your current doctor's services will be covered
  • Monthly premiums
  • Deductibles
  • Out-of-pocket maximums

The plan's reputation is also important. Plans with a 5-star rating are your best bet.