Medicare Advantage

MEDICARE ADVANTAGE

What is Medicare Advantage?

Medicare Advantage is also known as Medicare Part C and is an “all-in-one” alternative to original Medicare. However, unlike Parts A & B, Medicare Advantage plans are offered by Medicare-approved insurance companies. These plans must offer at least the same level of coverage as Medicare Parts A & B but many will include additional benefits. These additional benefits may include things like: prescription drug coverage (Part D), dental, basic vision, hearing services, gym memberships, over-the-counter medicines, transportation services, wellness programs and more.

Eligibility

Eligibility requirements are simple. If you are eligible for Medicare you are eligible for Medicare Advantage however, you must be enrolled in both Medicare Part A and Part B before enrolling in a Medicare Advantage plan. It is important to understand that not all Advantage plans are available everywhere so, when you see certain benefits advertised on television, they may not be available in your service area. You also can’t be denied access to an Advantage plan for existing health conditions so as long as you are utilizing a valid election period, you can join a Medicare Advantage plan.

Types of Medicare Advantage Plans

Preferred Provider Organization (PPO): These plans cover both in-network and out-of-network providers and facilities however, you will usually pay more if you go out of the network. PPO’s also don’t require you to choose a primary care physician or obtain a referral to see a specialist.

Health Maintenance Organization (HMO): These plans typically only cover in-network providers so it is important to choose a primary care physician in network and see other providers within the plan’s network – except for in emergency situations. You may also need your primary care physician to provide a referral to see a specialist.

HMO Point-of-Service (HMO-POS): Similar to other HMO’s you are going to have a network of providers however, the HMO-POS plan may allow you to get some services out-of-network for a higher copayment or coinsurance.

Special Needs Plan (SNP): These plans are designed for people with certain special needs so not all Medicare beneficiaries are eligible for these plans. There are three types of these Special Needs plans. Dual-Eligible Special Needs Plans are designed for those individuals who have both Medicare and Medicaid benefits. Chronic-Condition Special Needs Plans are for for people with disabling chronic illnesses which can include things like autoimmune diseases, cancer, dementia and other chronic conditions. Lastly, there are Institutional Special Needs Plans which are for people living in an institution like a long-term care facility or who may require nursing care at home.

Medical Savings Account (MSA): MSA plans are high deductible health plans and will combine the plan with a bank account to help pay for medical costs. Once you meet the deductible the plan provides you with coverage. The plan will deposit money into the savings account that you can use to pay toward the deductible.

Private Fee-for-Service (PFFS): PFFS plans may have a healthcare provider network but you can still typically go out-of-network if the provider accepts the plan’s payment terms and conditions. Your plan determines how much the provider pays for your healthcare and how much you do. This differs from other Medicare plans because with other plans Medicare sets the rates, not the plan.