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.
Types of Medicare Advantage (Part C) plans
It’s important to understand the differences between the types of Medicare Advantage plans to see which works best for you. There are several different types of Medicare
Health Maintenance Organization
Lets you see doctors and other health professionals who participate in its provider network. If your doctor is already in network, it could be a good option because you tend to pay less out-of-pocket for in-network doctors.
Preferred Provider Organization
Covers both in- and out-of-network providers, giving you the freedom to choose any doctor that accepts Medicare assignment, which can work if you prefer that kind of flexibility.
The plan determines how much it will pay providers and how much you must pay when you get care. The treating doctor has to accept the plan’s payment terms and agree to treat you. If the doctor doesn’t agree to those terms, then the PFFS plan will not cover services through that doctor.
Special Needs Plans
Are especially for people who have certain special needs. The three different SNP plans cover Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions such as diabetes, End Stage Renal Disease (ESRD), or HIV/AIDS. This type of plan always includes prescription drug coverage.
Health Maintenance Organization – Point of Service
Covers both in- and out-of-network health services, but at different rates. You pay less out-of-pocket when you go to in-network doctors, labs, hospitals, and other health care providers.
Medical Savings Account
Includes both a high deductible and a bank account to help you pay that deductible. The amount deposited into the account varies from plan to plan. The money is tax-free as long as you use it on IRS-qualified medical expenses, which include the health plan’s deductible.
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.
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This book helps you learn about the different parts of the Medicare program, including Medicare Part A and Part B (together, they are often called “Original Medicare”), Part C (often called “Medicare Advantage”) and Part D (the part of Medicare that covers your prescription medications).
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
Florida Health Agency is a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.