Medicare Advantage Plans


 
Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” When you join a Medicare Advantage Plan, you are still in Medicare.

      With Medicare Advantage Plans:
  • Some of the plans require referrals to see specialists.
  • In many cases, the premiums or the costs of services (co-pays and deductibles) can be lower than they are in Original Medicare or Original Medicare with a Medigap policy although some Medicare Advantage plans do not charge a premium. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
  • The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
  • They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
  • They generally offer extra benefits, and many include prescription drug coverage.
  • In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
  • Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
  • You don’t need to buy a Medigap policy.

Types of Medicare Advantage Health Plans include:

Medicare Advantage- Coordinated care plans-HMO’s:

A type of Medicare Health Plan that is available in most areas of the country. Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Your costs may be lower than in Original Medicare.

Medicare Advantage- Coordinated care plans-PPO’s:

A type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Medicare Advantage- Private Fee For Service (PFFS) Plans:

A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits Original Medicare doesn’t cover.

Medicare Advantage-Medical Savings Account (MSA) Plans:

A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits Original Medicare doesn’t cover.

Medicare Advantage- Special Needs Plans:

A special type of Medicare Advantage Plan that provides all Medicare Part A and Part B health care and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management. These plans may limit membership to people

  • in certain institutions (like a nursing home),
  • eligible for both Medicare and Medicaid, or
  • with certain chronic or disabling conditions.

Other Medicare Health Plans

There are some types of Medicare Health Plans that aren’t part of Medicare Advantage, but are still part of the Medicare Program. With these plans, you generally get all your Medicare-covered health care through that plan. Some plans cover prescription drugs.

These other Medicare Health Plans include:

Medicare Cost Plans
Demonstartion/Cost Plans
PACE (Programs of All-inclusive Care for the Elderly)