Medicare

What is a Medicare Advantage Plan?

Medicare Advantage plans are offered by Medicare-approved Private insurance companies to provide coverage for your Medicare Part A & B. Medicare Advantage plans are sometimes called "Part C" or "MA or MA-PD Plans". Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care (hospice is still covered by Original Medicare even if you have an Advantage Plan).

Most Medicare Advantage Plans offer additional coverages that Original Medicare does not offer, such as, dental, vision, hearing, over-the-counter benefits and Prescription Drug (Part D).

Some Medicare Advantage plans have a monthly premium that you would have to pay in addition to your Part B premium.

There are several different types of Medicare Advantage Plans available, however, not all plans are available in all areas. Figuring out if your doctor(s) are in or out of network with any of these plans is important as it plays a big roll in your copays and coinsurance.

Health maintenance Organization - Point of Service (HMO-POS)

HMO-POS uses a network of doctors and facilities but also have a limited ability to go outside of that network as long as the provider will accept the plan, however, this will generally have higher costs, except in urgent or emergency situations.

Health maintenance Organization (HMO)

HMO plans limit use to their network of doctors and facilities, except in urgent or emergency situations. Most plans will require a referral to see a specialist.

Preferred Provider Organization (PPO)

PPO plans allow you to go outside of their network but will usually cost you more in copays and coinsurance, except in urgent or emergency situations. However, providers can choose to not accept a plan out-of-network.

Private Fee For Service (PFFS)

PFFS plans allow you to go to any Medicare-approved provider or facility that accepts the plan's payment terms, agrees to treat you, and hasn't opted out of Medicare (for Part A- and Part B- covered items and services), except in urgent or emergency situations.

Special Needs Plan (SNP)

An SNP provides benefits and services to people with specific conditions, certain health care needs, or who have Medicaid. SNPs also included care coordination services and tailor benefits, provider choices, and list of covered drugs to make sure their special needs are being treated properly.