In our last post we learned about Medicare Prescription Drug Plans. 

Today we move on to learn more about Medicare Advantage Plans.

Let’s get started.

What are Medicare Advantage Plans?

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” are offered by Medicare-approved private companies that must follow rules set by Medicare.

Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans. Each of these Medicare Advantage Plan types have special rules about how you get your Medicare covered Part A and B services and your plan’s supplemental benefits.

In many Medicare Advantage Plans, you’ll need to use health care providers who participate in the plan’s network and service area. Before you enroll, you may want to check with your providers and the plan you’re considering to make sure the providers you currently see, or want to see in the future, are in the plan’s network.

There are different types of Medicare Advantage Plans:

• Health Maintenance Organization (HMO) Plans
• Preferred Provider Organization (PPO)
• Private Fee-for-Service (PFFS) Plans
• Special Needs Plans (SNPs)
• Medical Savings Account(MSA)Plans

What is the difference between a HMO plan and a PPO plan?

HMOs and PPOs tend to be the most common types of Medicare Advantage Plans.  The availability of these plans is all based your local area.  Generally, for those with HMO Plans you will have to utilize providers in the network (except for emergencies). PPOs on the other hand also have network providers but you do have the option to use out of network providers, but just pay more for using out of network providers.

What do Medicare Advantage Plans cover?

Medicare Advantage Plans cover almost all Part A and Part B services. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. 

Most Medicare Advantage Plans offer coverage, for some things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts).

Plans also have a yearly limit on your out-of-pocket costs for all Part A and Part B medical services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover.

Medicare drug coverage (Part D)

Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private-Fee-for-Service Plans), you can join a separate Medicare drug plan.

However, if you join a Health Maintenance Organization or Preferred Provider Organization plan which doesn’t cover drugs, you can’t join a separate Medicare drug plan.

What if I have a pre-existing condition?

You can join a Medicare Advantage Plan even if you have a pre-existing condition.

Medicare Advantage Plans generally are good options for beneficiaries that: 

• Are on a limited budget
• Don’t mind having a network of doctors and hospitals
• Don’t mind having co-pays
• Would like benefits beyond Medicare

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You can view my Power 5 Video on the content below

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This concludes our introduction to Medicare Advantage Plans.  As a reminder, every individual situation is different so it is important that we review each person’s needs individually to fully access your options.

Thank you for taking the time to read. Coming up next we will review what you will pay for Medicare.

If you have questions in the meantime – I’m here for you – drop me a line or give me a call.