Are you thinking about one of the Advantage Plans?


What’s a Medicare Advantage Plan?

You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO).  If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA / MAPD Plans,” are offered by private insurance companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare  Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.  This is different than a Medicare Supplement Insurance (Medigap) policy.


What do I need to know about Medicare Advantage Plans?

These are the different types of Medicare Advantage Plans:

• Health Maintenance Organization (HMO) plans — In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.

• Preferred Provider Organization (PPO) plans — In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.

• Private Fee-for-Service (PFFS) plans — PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

• Special Needs Plans (SNPs)  — SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

• HMO Point-of-Service (HMOPOS) plans — These are HMO plans that may allow you to get some services out-of-network for a higher co-payment or co-insurance.

• Medical Savings Account (MSA) plans — These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan. For more information about MSAs, visit Medicare.gov/publications to view the booklet “Your Guide to Medicare Medical Savings Account Plans.” 


Who can join a Medicare Advantage Plan?

You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan. 


How much do Medicare Advantage Plans cost?

In addition to your Part B premium, each Medicare Advantage Plan has different premiums (there are still some plans which are premium free) and co-pays or costs for services, so it’s important to compare plans in your area and understand plan costs, benefits and networks before you join. Just contact us, and we will be happy to do the research, comparisons, explained the coverage and of course answer any of your questions and concerns. 

What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, and Silver Sneakers program.

Most Medicare Advantage Plans  (MAPD) include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage.

Plan benefits can change from year to year.  The Annual Election Period (A.E.P.) is from October 15th thru December 7th, during this time, unless you qualify for a life changing event (S.E.P.), is normally the only time you can change or dis-enroll from a plan. Make sure you understand how a plan works before you join.

Medicare has neither reviewed nor endorsed this information.