Understanding Medicare Advantage Plans

If you already have Original Medicare and you would like to get more Medicare benefits, you should consider joining a Medicare Advantage Plan. There are certain additional benefits you get if you join one of these and your out-of-pocket costs may reduce. In this article we will give you the basic information you need in order to understand how these plans work and decide whether they are what you are looking for or not.

What is a Medicare Advantage Plan?

     Medicare Advantage Plans, also known as “Part C” or MA “Plans”, are plans that provide your entire Medicare, including complete coverage of Part A (hospital insurance) and Part B (Medicare Insurance). These Plans are offered by private companies approved by Medicare, which pays the Medicare benefits coverage to the company. If you want to join a MA Plan, you must have Original Medicare Part A and Part B. If the person has a pre-existing condition, he or she can get an Advantage Plan, unless the person suffers from End-Stage Renal Disease (ESRD or permanent kidney failure), in that case he or she won’t be able to get and Advantage Plan. You can only join a plan at certain times during the year and you’re enrolled in a plan for a year.

      What benefits do I get from Medicare Advantage Plans?

Advantage Plans cover all the services of Original Medicare except for hospice care, which will still be covered by Original Medicare even if you join the Advantage Plan. You will also be covered for emergency and urgent care, including emergency coverage outside of the plan’s service area. The majority of Advantage Plans cover Medicare prescription drug coverage (Part D) and many of them offer extra benefits such as dental care, hearing care, eyeglasses, or wellness programs.

Another important benefit you get from MA Plans is that your out-of-pocket costs are usually lower and they have a yearly limit on your out-of-pocket costs for medical services, which varies depending on the plan and could change each year. Once the person reaches this limit, he or she won’t pay anything for covered services. Do not confuse these with Medicare Supplement Plans (Medigap policies), they are not the same and offer other completely different benefits. Also, you are not allowed to have both of them (Advantage plans and Medigap) at the same time. Take into consideration that when you are enrolled in a Medicare Advantage Plan you are still in the Medicare program and you still have Medicare rights and protections.

Find out more here

     What types of Medicare Advantage Plans are available?

     There are six types of MA Plans:

  1. Health Maintenance Organization (HMO) plans, in which you are only allowed to go to doctors, other health care providers, or hospitals in the plan’s network, except for an emergency situation.
  2. Preferred Provider Organization (PPO) plans, in which the person pays less if he or she uses doctors, hospitals, and other health care providers that belong to the plan’s network.
  3. Private Fee-for-Service (PFFS) plans in which the person can generally go to any doctor, other health care provider or hospital as long as they accept the plan’s payment terms.
  4. Special Needs Plans (SNPs), which offer focused and specialized health care for specific groups of people, like someone who has a certain chronic medical condition.
  5. HMO Point-of-Service (HMOPOS) plans, which allow the person to get some services out-of-network for a higher copayment or coinsurance. This one is not as common as the plans above.
  6. Medical Savings Account (MSA) plans, which combine a high-deductible health plan with a bank account. Medicare deposits money into the account and the person can use the money to pay for his or her health care services during the year. This one is not as common as the plans above.