Whether you choose Medicare Advantage Plans one of the Medicare parts or Medicare Supplement Plans, sorting through the options can be very confusing and frustrating.
Taking ten minutes to thoroughly read this article should help alleviate the confusion regarding Medicare Advantage aka Medicare Part C.
We will review all of the Medicare Advantage Plans and the positives and negatives of each plan option.
What Are Medicare Advantage Plans?
You have two choices when it comes to the Medicare programs offered.
First, you can choose Original Medicare which includes Medicare Part A (Hospital coverage) and Medicare Part B (Doctor coverage).
Second, you can choose a Medicare Advantage Plan which are also known as MA Plans or Medicare Part C.
MA Plans are offered by private companies that contract with Original Medicare to provide all of your health insurance coverage.
Types of Medicare Advantage Plans
- Health Maintenance Organization Plans (HMO)
- Preferred Provider Organization Plans (PPO)
- Private Fee-for-Service Plans (PFFS)
- Special Needs Plans (SNPs)
- HMO Point-of-Service Plans (HMOPOS)
- Medical Savings Account Plans (MSA)
| Medicare Advantage | Medicare Supplements | |
|---|---|---|
| In Relation to Original Medicare Parts A & B | Private health plan that provides Part A & B benefits directly in place of Regular Medicare. | Private gap coverage that pays all or most Part A & B out-of-pocket expenses. |
| Premium | $0 to more than $100 a month depending on the plan. Anyone enrolled will pay the same no matter of age or health history. | Average of about $125 to $225 a month. Can vary by age, health history, or Company. |
| Out-of-pocket costs | In-network medical deductibles and co-pays of $5,000 up to $7,500 a year, depending on the plan. | Very Low Cost to None (excluding the monthly premium) |
| Choice of doctors and hospitals | HMO: Plan providers only. PPO: Any provider, but out-of-network providers cost more. | Any Provider that participates in Medicare. |
| When Can You Purchase | When you first enroll in both Medicare A and B and annually thereafter during Open Enrollment (Oct.15 – Dec.7). | First six months after you sign up for Part B and are at least 65 years old. |
| Part D Prescription Coverage | Most plans include Part D coverage. | Not included. You must buy a separate Part D plan for this. |
| How Provider Is Paid | You pay deductibles and Co-pays directly to providers. | Medigap almost always automatically cuts a check to providers after Medicare pays its share. |
Health Maintenance Organization Plans (HMO)
Traditional HMO plans only allow you to go to doctors, medical providers and hospitals within the HMO plans network. Medicare Advantage plans that use this type of network follow these same guidelines.
You may also need to get a referral from your primary physician for specialized tests and to see additional doctors or specialists.
Preferred Provider Organization Plans (PPO)
The PPO plans are very similar to the HMO plans.
There are in network doctors, hospitals and specialists that cost less if you use them.
However, unlike HMO, you are allowed to use out of network doctors, hospitals and specialists, at a higher cost.
Private Fee-for-Service Plans (PFFS)
The PFFS plans are very similar to Original Medicare, in the fact you can go to any doctor, hospital or specialist that will accept the plans payment terms.
These Medicare Advantage plans are each very different and based on the one you choose, it will determine how much of the cost you will be responsible for. Most PFFS plans have been replaced with PPO plans nationwide.
Special Needs Plans (SNPs)
The SNP plans are true to their name, for people with special medical needs.
Typically, people who have both Medicaid and Medicare, living in a nursing home or assisted living home, and or have more serious reoccurring medical conditions will choose these plans.
HMO Point-of-Service Plans (HMOPOS)
The HMOPOS is a hybrid plan of the traditional HMO and PPO plans.
They are very similar to PPO plans in that there is a network of doctors, hospitals and specialists you can use.
However, unlike HMO plans, you may be allowed to get some of your medical treatment outside of the network for an additional cost.
Medical Savings Account Plans (MSA)
The MSA is a high deductible health care plan.
Medicare will deposit money into your Medical Savings Account for you to use to pay for your health care throughout the year.
MSA plans do not offer drug coverage which would need to be purchased separately.
Medicare Advantage Insurance (Part C/MA Plans)
If you sign up for a Medicare Advantage plan, you still have Medicare. Keep in mind that there are specific times that you can enroll in Medicare Advantage plans. This can be done during your Initial Enrollment Period (IEP) when you are first going onto Medicare or during the Annual Enrollment Period (AEP). To understand more about the Annual Enrollment Period, click on our article here.
However, instead of using original Medicare, you will receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from a private company that Medicare approves.
MA plans typically include Health Maintenance Organizations (HMO), or Preferred Provider Organizations (PPO).
These Part C plans may offer extra coverage for dental, vision, and hearing, or for other health and wellness programs.
Most MA plans also include prescription drug coverage (Part D).
These Part C plans may offer extra coverage for dental, vision, and hearing, or for other health and wellness programs.
Most MA plans also include prescription drug coverage (Part D).
The plan becomes both your primary Medicare and secondary insurance in regards to provider billing.
In addition to the Part B premium, there may be another monthly premium for Medicare Advantage plans.
These plans are NOT guaranteed renewable and often change year to year.
An agent must complete Centers for Medicare (CMS Training) every year because of all of the changing information, benefits, plans, and premiums.
What Medicare Advantage Plans “Are”
Medicare Advantage plans “are” alternatives to Original Medicare.
What Medicare Advantage Plans “Are Not”
Medicare Advantage plans “Are NOT” Medicare Supplements. To understand more about Medicare Supplement plans click our article here. To understand a bit about how Medicare Supplement rates work click our article here.
Take Action!
Senior Benefit Services’ agents are well versed in both Medicare Supplement Plans and Medicare Advantage plans to help you figure out what’s best for your personal scenario.
There are MANY factors to evaluate and you should keep in mind that no decision should be taken lightly. Let one of our local agents be that trusted source for you!