Let’s get basic with Medicare Advantage Plans.
You may also hear these plans called “Part C” or “MA Plans.”
They’re offered by private companies that have been approved by Medicare.
When you join a Medicare Advantage Plan, you still have Medicare, though your hospital (Part A) and medical (Part B) coverage will be provided through this plan, as opposed to Original Medicare.
Here’s a breakdown of your Medicare Advantage options.
Health Maintenance Organization Plans
You’ve probably heard the term “HMO,” even if you don’t necessarily know what it’s all about.
If you have an HMO, you can usually only use doctors, hospitals, or other healthcare providers on the plan’s list, and you may have to get a referral from your primary care doctor in order to be seen.
There are exceptions to this, including:
- Emergency care.
- Out-of-area urgent care.
- Out-of-area dialysis.
Most HMO’s will include prescription drug coverage.
Preferred Provider Organization Plans
Also known as PPO’s, these plans allow you to use providers who aren’t in your plan’s network, though you will have to pay a higher cost.
Most of the time, prescription drugs will be covered.
Unlike an HMO, a PPO doesn’t require you to choose a primary care physician and you don’t have to have a referral to see specialists.
Private Fee-for-Service Plans
A PFFS sets a certain amount that they will pay for doctors, healthcare providers, and hospitals.
Your ability to see any providers you want will depend on the plan that you decide to go with.
Some will allow you to see anyone, while others will restrict you to a certain network, though you can still see an out-of-network doctor at a higher cost.
Prescription coverage will also depend on the plan you choose. There are some PFFS plans that include prescriptions.
If you choose one that doesn’t, you can join a Medicare Prescription Drug Plan.
You don’t need to choose a primary care physician or get a referral to see specialists when necessary.
Special Needs Plans
SNP’s have a specific scope.
They are for those who have certain diseases or issues.
This type of plan is characterized by tailored benefits, providers, and drugs that meet the needs of the group they serve.
Your care would need to come from certain doctors or hospitals, unless:
- You’re in an emergency or urgent situation.
- You need out-of-the-area dialysis for end-stage renal disease.
SNP’s are required to provide prescription drug coverage, you do have to choose a primary care physician and you have to get a referral in order to see a specialist.
$0 Premium Plans
$0 Premium plans are available when Medicare Advantage partners with the Centers for Medicare and Medicaid Services.
Basically, the federal government pays a flat rate to the insurance company to fund the costs of your coverage. This amount is determined by your age, sex, and health status.
It’s important that you understand that a $0 Premium plan may still require that you pay copays, deductibles, and coinsurance costs.
There is a cap, however, on how much you would have to pay in a calendar year.
This plan does involve working with a network of doctors and healthcare providers.
Choosing the right path
Though you’ve been given a run-down of the different Medicare Advantage plans, you may still be a little confused as to what the right choice is for you.
Your best bet is to talk with an independent insurance expert who can go over the options with you in greater detail.
Call us today and we’ll guide you toward the plan that best fits your particular needs.
Which plan or plans sound as if they may be a good fit for you?