Understanding Medicare Advantage Plans
Medicare Advantage Plans (also called Part C or MA Plans) offer an alternative to Original Medicare. These plans, provided by private companies approved by Medicare, cover both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), with additional benefits.
Medicare Advantage Plans include several types:
✓ Health Maintenance Organization (HMO):
Typically, these plans require you to use doctors and hospitals within the plan’s network, except in emergency situations. You may also need a referral to see specialists.
✓ Preferred Provider Organization (PPO):
In a PPO, you can use out-of-network providers, but you’ll pay less for in-network services. Out-of-network care costs more.
✓ Private Fee-for-Service (PFFS):
These plans work like Original Medicare in that you can see any provider who accepts the plan’s terms, though costs and coverage vary by plan.
✓ Special Needs Plans (SNPs):
Tailored for individuals with specific health conditions, these plans offer specialized care for people with Medicare and Medicaid, those in nursing homes, or those with chronic conditions.
✓ HMO Point-of-Service (HMO-POS):
These plans are similar to HMO plans but may allow limited out-of-network coverage at higher costs.
Eligibility:
To join a Medicare Advantage Plan, you must have both Medicare Part A and Part B and live in the plan’s service area. Individuals with End-Stage Renal Disease (ESRD) generally cannot join these plans.
Costs:
Along with your Part B premium, Medicare Advantage Plans typically charge one monthly premium that covers all included benefits, including medical and prescription drug coverage. Costs vary, so it's important to compare plans in your area.
Coverage:
Medicare Advantage Plans must cover all services offered by Original Medicare, except for hospice care. Many plans also offer additional benefits such as dental, vision, and wellness programs. Most include prescription drug coverage (Part D), but plan features can change annually.
Medicare Advantage Plans include several types:
✓ Health Maintenance Organization (HMO):
Typically, these plans require you to use doctors and hospitals within the plan’s network, except in emergency situations. You may also need a referral to see specialists.
✓ Preferred Provider Organization (PPO):
In a PPO, you can use out-of-network providers, but you’ll pay less for in-network services. Out-of-network care costs more.
✓ Private Fee-for-Service (PFFS):
These plans work like Original Medicare in that you can see any provider who accepts the plan’s terms, though costs and coverage vary by plan.
✓ Special Needs Plans (SNPs):
Tailored for individuals with specific health conditions, these plans offer specialized care for people with Medicare and Medicaid, those in nursing homes, or those with chronic conditions.
✓ HMO Point-of-Service (HMO-POS):
These plans are similar to HMO plans but may allow limited out-of-network coverage at higher costs.
Eligibility:
To join a Medicare Advantage Plan, you must have both Medicare Part A and Part B and live in the plan’s service area. Individuals with End-Stage Renal Disease (ESRD) generally cannot join these plans.
Costs:
Along with your Part B premium, Medicare Advantage Plans typically charge one monthly premium that covers all included benefits, including medical and prescription drug coverage. Costs vary, so it's important to compare plans in your area.
Coverage:
Medicare Advantage Plans must cover all services offered by Original Medicare, except for hospice care. Many plans also offer additional benefits such as dental, vision, and wellness programs. Most include prescription drug coverage (Part D), but plan features can change annually.
Ready to Get Started?
For FREE