Medicare Advantage (Part C)

Medicare Advantage plans allow you to receive your benefits from a private insurance company approved by Medicare. If you have Medicare Part A and Medicare Part B, you can receive your benefits from a Medicare Advantage plan. Medicare Advantage plans are not supplemental insurance, but rather health insurance plans of their own. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental. Medicare Advantage plans must follow guidelines established by Medicare, but they can vary in terms of costs and rules.

Medicare Advantage Payments and Enrollment

With a Medicare Advantage plan, you may be able to lower your out-of-pocket costs. Some Medicare Advantage plans have lower co-payments than Medicare Parts A and B, but are also limited to certain service areas and often involve networks. You may have to pay a premium each month due to the extra benefits you may receive from the plan. You can enroll in a Medicare Advantage Plan during your (IEP) Initial Enrollment Period, the Medicare Advantage and Prescription Drug Plan Annual Enrollment Period and there are also (SEP) Special Enrollment Periods for certain situations. The amount that you pay yourself varies from plan to plan, so it is necessary to compare plans in order to find the plan most suitable to your needs. You can enroll in plans by paper, telephone, or an online application.

Choices and Options with Medicare Advantage

1. Health Maintenance Organization (HMO) plans are required to cover both Part A and Part B health care, but can also offer additional benefits. You will only be able to visit physicians and hospitals that are within the HMO network unless there is an emergency. However, HMOs can lower costs, making them (in some cases) less expensive than Medicare Parts A and B..
2. Preferred Provider Organizations (PPOs) allow you to use doctors, hospitals, and specialists within the PPO network. However, you are permitted to use health providers outside of the network at an additional cost to you without a referral..
3. With a Private Fee for Service (PFFS) you are able to use any doctor or specialist, so long as they accept the terms, fees, and conditions of the PFFS. The plan chooses how much it will pay for the services, and you can spend more or less on PFFS plans than Medicare Parts A and B.
4. In a Medicare Medical Savings Account (MSA) you combine a medical savings account with a high-deductible. Medicare gives the plan an amount of money each year for your health care and the plan deposits this money into your account. You can use this money to pay for health care costs, even if they’re not covered by Medicare. If you use it for Medicare Part A and Medicare Part B services, you can count this towards your deductible. If you have used the money provided but have additional health care costs, you’ll have to pay for the Medicare-covered services out-of-pocket. After you reach your deductible, the plan will cover Medicare-covered services.

Are there any risks and what if I’m not satisfied?

If you have a Medicare Advantage Plan, you can’t have a Medigap policy, because Medicare Advantage Plans cover many of the same benefits and you can not be enrolled in two medical plans at the same time. With a Medicare Advantage Plan, you are still in the Medicare program and can still get complete Part A and Part B coverage through the plan. If the plan opts to end its involvement with Medicare, you will need to choose another plan or enroll in Medicare Parts A and B. You may have guaranteed issue rights if this happens.

Medicare Advantage plans may offer additional benefits that may not be available through Medicare Parts A and B. Medicare Advantage plans are offered through private insurance companies and can be customized for your own unique needs. There are different types of Medicare Advantage plans: Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), Medicare Medical Savings Account Plans (MSA) and HMO Point of Service Plans (HMOPOS).

One important difference between them is where you can get covered treatment.
PPO … Preferred Provider Organization … has what is commonly referred to as a network of coverage. This means that there is a network of preferred facilities and physicians that are pre-approved for coverage with your plan. As long as you stay within this network, you will not incur any unexpected costs from covered procedures and examinations. The Medicare Advantage Plan you choose can also make a difference in your out-of-pocket costs and have may have different rules for how you get certain services like whether you need a referral to see a specialist.

HMO… Health Maintenance Organizations have a network of pre-approved service providers that will be covered within your plan, however, one main difference is that in most cases you must select a primary care physician. This primary care physician acts as your personal doctor, but also as your health care coordinator. If you ever needed to see a specialty doctor who was not in your HMO plan network, your primary care physician could offer you a referral if they deemed it necessary. You may need to obtain a referral from your primary care physician in order for the service to be covered.

By knowing what doctors are important to your healthcare, you can make a much more informed decision about what plan will serve you best.