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Medicare Advantage Plans

When people think about enrolling in Medicare, they will oftentimes automatically think about Medicare Parts A and B. These parts of Medicare are referred to as Original Medicare. This is because they were the initial parts of the Medicare health care plan that covered seniors who are age 65 and over.

With Medicare Part A, individuals are covered for hospitalization services. This includes actual inpatient hospital care, as well as some coverage if the enrollee enters into a skilled nursing home facility, and some hospice care.

Medicare Part B covers doctors’ services. This includes services such as lab tests, surgery, and doctor visits, as well as necessary supplies such as walkers and wheelchairs. It is important to note that the care and supplies that are covered must be considered to be medically necessary in order to treat a condition or a disease.

There are also certain types of preventive services that are covered by Medicare Part B. These are covered if they are for the purpose of preventing illness such as the flu, or to detect certain illnesses at an early stage when treatment is the most likely to work. If a medical provider accepts Medicare assignment, the enrollee will typically pay nothing for this care.

Some of the other items that are covered by Medicare Part B include clinical research, ambulance services, durable medical equipment, and services for the treatment of mental health such as inpatient, outpatient, and partial hospitalization.

Options for Medicare Other Than Part A and Part B

For those who wish to receive their Medicare services in a format other than Original Medicare, there is Medicare Advantage. This manner of receiving Medicare is also referred to as Medicare Part C. Medicare Advantage plans are a type of Medicare that is offered through private health insurance companies that are contracted with Medicare.

When someone has a Medicare Advantage plan, they will still receive Medicare Part A and Part B benefits. However, they may receive them in a different format, such as through an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). When services are received in this way, the Medicare Advantage plan enrollee may be required to choose a provider from within a particular network. Medicare Advantage plans may also offer additional coverages that are over and above what is offered through Medicare Parts A and B such as dental care and vision coverage.

What are the Different Types of Medicare Advantage Plans?

There are actually several different types of Medicare Advantage plans that are available to choose from. These include the following:

  • HMO (Health Maintenance Organization) – Those who are enrolled in an HMO plan are typically required to go to doctors and facilities that are listed within a particular network (other than in an emergency situation). HMO plans will also usually require that their enrollees choose a primary care physician. That physician will oftentimes act as a “gatekeeper” who can provide the enrollee with a referral if the enrollee needs one in order to see a specialist. In most cases, Medicare Advantage HMO plans will automatically cover prescription drugs.
  • PPO (Preferred Provider Organization) – A Medicare Advantage PPO plan has some similarities to an HMO plan in that it, too, provides enrollees with a network of doctors and facilities to choose from. Enrollees will typically pay less if they choose to use these providers, however, they can opt to use other, out of network providers and facilities as well. Typically, prescription drugs are also automatically in these types of Medicare Advantage plans. Unlike with an HMO, PPOs do not require that individuals choose a primary care physician, nor do individuals need to obtain a referral in order to visit a specialist.
  • PFFS (Private Fee for Service) – In a Private Fee for Service plan, the plan will pre-determine the amount that it will pay to hospitals and other health care providers, as well as how much the plan’s enrollees must pay when they receive their care. In certain cases, enrollees are able to obtain their care from any health care provider or facility of their choosing – as long as the facility or provider accepts Medicare and the plan’s payment terms. Some PFFS Medicare Advantage plans will have a network of providers that enrollees will need to choose from. In these plans, prescription drugs may or may not be covered. It is typically not required that an enrollee choose a primary care physician, nor is it necessary to obtain a referral in order to see a specialist.
  • SNP (Special Needs Plan) – Special Needs Medicare Advantage Plans are somewhat similar to HMOs or PPOs. These plans, however, limit their enrollment to those who have certain types of illnesses or characteristics. The enrollees who are in SNP plans must typically get their services and care from facilities and providers that are within a network – other than in emergency situations. It is a requirement that all Special Needs Plans provide Medicare prescription drug coverage. It is also required – in most instances – that enrollees have a primary care physician. If this is not the case with an enrollee, it is likely that he or she will need to have a care coordinator who can help them with their health care needs.
  • MSA (Medical Savings Account) – A Medical Savings Account, or MSA, Medicare Advantage plan is a type of plan that combines a high deductible health insurance plan with a bank account where funds can be set aside. Medicare will deposit funds into the bank account and the enrollee can use these funds in order to pay for their health care services throughout the year. The amount of money that is deposited into the MSA account is typically less than the amount of the deductible on the health insurance plan.

Who is Eligible for a Medicare Advantage Plan?

Medicare Advantage plans are not for everyone, so it is important to understand who is eligible to enroll and who is not. First, in order to be able to join this type of a plan, a person must be at least age 65 and enrolled in Medicare. In addition, the individual must not have end stage renal disease. It is also important to note that you must live within the service are of the Medicare Advantage plan that you are interested in joining.

Medicare Advantage plans are not offered through the U.S. government, but rather through private health insurance companies. Therefore, it is a good idea to shop around for the coverage that you feel will best suit your specific needs.

When doing so, we can help. We work with many of the top Medicare Advantage plan providers in the market place today, and we can get you the information that you need quickly and conveniently, right from your home computer. All you need to do in order to get the process started, is simply fill out the form on this page.

Should you have any additional questions regarding Medicare Advantage plans, how this type of coverage works, or how to compare Medicare Advantage with Original Medicare Parts A and B, please feel free to contact us directly. Our experts can walk you through the information that you need in order to make an informed decision.