Medicare Advantage Plans

What is a Medicare Advantage Plan?

Medicare Advantage plans, also known as Medicare Part C, are increasingly popular as a way for Medicare beneficiaries to get the coverage they need. These plans are a type of private health insurance offered by private companies that contracts with Medicare to provide all of the same benefits as Original Medicare, Part A and Part B, plus more.

These plans are designed to provide more comprehensive coverage than Original Medicare. They may include coverage for prescription drugs, vision, hearing, dental and other services. The premiums are typically lower than with traditional Medicare, and enrollees may have access to additional benefits and services. In addition, these plans often have low or no copays and deductibles for certain services. In order to be eligible for Medicare Advantage plans, you must be enrolled in both Part A and Part B of Medicare. You also must live in the plan’s service area and not have end–stage renal disease (ESRD).

What types of Medicare Advantage plans are available?

When it comes to choosing a Medicare Advantage plan, there are several different types of plans available, including:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Private Fee–for–Service plans (PFFS)
• Special Needs Plans (SNPs)
•  Medicare Medical Savings Account (MSA) plans

HMOs are the most common type of Medicare Advantage plan. With an HMO, you choose a primary care doctor from the plan‘s network of providers who will coordinate all of your care. You usually need a referral from your primary care doctor in order to see a specialist and you‘re usually required to get your care from within the plan‘s network.

PPOs are similar to HMOs in that you select a primary care doctor from the plan‘s network of providers. However, with a PPO, you have more flexibility to see out–of–network providers without needing a referral from your primary care doctor. You may also have to pay more for out–of–network care.

Private Fee–for–Service plans (PFFS) allow you to get care from any provider who will accept the plan‘s payment terms and agree to provide services to plan members. The services may be provided in or out of the plan‘s network.

Special Needs Plans (SNPs) are designed for people who have serious or chronic health conditions and are enrolled in both Medicare and Medicaid, or who require care in a nursing home. These plans provide more tailored coverage and may even include additional benefits and services not covered by Original Medicare.

Finally, Medicare Medical Savings Account (MSA) plans combine a high–deductible health insurance plan with a savings account. The savings account is used to pay for certain medical expenses, such as deductibles and copayments. The money in the account is yours to keep, even if you switch plans.

How do I pick the right plan?

When selecting a Medicare Advantage plan, it‘s important to compare plans side by side to make sure you‘re getting the coverage you need. Be sure to consider the plan‘s premiums, deductibles, copayments, and other out–of–pocket costs. You‘ll also want to compare the plan‘s network of providers to make sure you can get the care you need. Medicare Advantage plans can be a great way to get the coverage you need at a lower cost. However, it‘s important to make sure you understand the details of the plan before you enroll. If you have questions, it‘s always a good idea to contact a Medicare specialist at LMS Insurance Group. 

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