Medicare Advantage Plans

Also referred to as “Part C” or “MA Plans”, Medicare Advantage Plans act as an alternative way of receiving your Original Medicare, and are provided by private companies that have been initially permitted by Medicare. A lot of these Medicare Advantage plans offer perks that go beyond an Original Medicare, for instance, prescription medicine coverage or routine dental services. In general, these plans include:

• Special Needs Plans
• Preferred Provider Organizations
• Private Free-for-Service Plans
• Medical Medicare Savings Account Plans
• Healthcare Maintenance Organizations

What Services are Covered by Medicare Advantage Plans?

Medicare Advantage Plans should cover all the services that are covered by the Original Medicare usually with other optional benefits included. In all forms of Medicare Advantage Plans, you are always covered for urgent and emergency care. These plans must also offer emergency coverage outside of the plan’s service area, though not al include coverage outside of the US. Many also come with additional benefits like eyeglasses, wellness programs, or dental care.

A majority of Medicare Advantage Plans include prescription medicine coverage, and the benefits can change from one year to the next. So make sure you properly understand how a plan works before joining. Also, you should be prepared to review your plan annually as things can change (often dramatically) from year to year.

How Do The Plans Differ?

Different Medicare Advantage plans come with different rules for obtaining these services. Some policies may require you to get a referral from your primary doctor if you wish to see a specialist. In such cases, if you fail to get a referral, the specialist’s services may not be completely covered. Just like that, with certain types of plans, if you receive any health care services from third-party providers, the plan may reject to cover the services, or you may be charged higher out-of-pocket expenses.

Another difference between Medicare Advantage plans is the amount of money you spend on various health care services. Some of these plans charge a premium on a monthly basis in addition to your Medicare Part B premium, while yearly deductibles, coinsurance, and copayments can also differ drastically between plans. Regardless of the type of plan you have, you will need to continue paying your Part B premium.

What Are the Rules for Medicare Advantage Plans?

Medicare spends a set amount of money for your healthcare on a monthly basis to the companies providing Medicare Advantage Plans. These companies are expected to follow a set of rules as put forward by the Medicare:

Every Medicare Advantage Plan can charge varying out-of-pocket expenses. They can also have different rules regarding how you receive services, such as:

• Whether you require a referral to visit a specialist
• If you have to go to facilities, suppliers, or doctors who belong to the plan for non-urgent or non-emergency care.

These rules are subject to change every year.