Medicare Advantage

What are Medicare Advantage plans (like HMOs and PPOs)?

Medicare Advantage Plans are health plan options that have been approved by Medicare but are run through private companies.They are part of the Medicare program, sometimes referred to as “part C.” If you join a Medicare Advantage plans you are still in Medicare.

Medicare Advantage Plans provide all of your Part A and Part B coverage, and must cover medically-necessary services. They often offer extra benefits, and many include Part D drug coverage.

Medicare Advantage Plans include:
  • Preferred Provider Organization Plans (PPO)
  • Health Maintenance Organization Plans (HMO)
  • Private Fee-for-Service Plans (PFFS)
  • Special Need Plans
  • Medicare Medical Savings Account Plans (MSA)

Who Can Join?
  • You live in the service area of the plan you are considering joining.
  • You have Medicare Part A and Part B. Although, if you are already in a Medicare Advantage Plan and have only Part B, you may stay in your plan.
  • You do not have End-Stage-Renal Disease.

If you Join:
  • You are still in the Medicare Program
  • You still have Medicare rights and protections
  • You still get complete Medicare Part A and Part B coverage.
  • You usually get prescription drug coverage through the plan.
  • You may be able to get extra benefits offered byt the plan, such as coverage for vision, hearing, dental, and/or health and wellness programs.
  • You still pay the Part B premium, as well as the Med. Advantage premium.
  • You usually will have to pay some other costs for the services you recieve.
  • You don’t need to buy a Medigap Policy Comparing How Three Types of Medicare Advantage Plans Work

Are prescription In most cases. In most cases. Sometimes drugs covered?

Do I need to No Yes No choose a primary care doctory?

Can I get my Yes No In most cases. health care from any doctor or hospital

Do I have to see a primary care No In most cases. No doctor to get a referral to see a specialist?

Medicare Special Needs Plans
These plans are specially designed for people with chronic diseases and other specialized health needs. These plans must provide all Medicare Part A and Part B helath care and services. They also must provide Medicare prescirption drug coverage. Generally, they offer extra benefits and have lower copayments than the Origanal Medicare Plan.

Medicare Medical Saving Account Plans
These plans are similar to Health Savings Account plans available outside of Medicare, and they have two parts. The first part is a Medicare Advantage Health Plan with a high deductible. This health plan won’t begin to pay covered costs until you have met the annual deductible, which varies by plan. The second part is a Medical Savings Account into which Medicare deposits money that you may use to pay health care costs.