What is a Medicare Advantage Plan?

In today’s economy, it is especially important that seniors who are enrolled in Original Medicare to consider a Medicare Advantage Plan.  It’s also just as important to know what a Medicare Advantage Plan can do for you.  Keep reading for all the details on Medicare Advantage plans, or call for a free personal consultation at 844-528-8688.

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Most seniors in America are aware of Medicare and understand the basics of what it will cover and more importantly, what it will not cover. Original Medicare (as it is known) was never intended to pay for every health care service you receive, but it does, however, pick up the tab for a lot of it. 

Regretfully, for many seniors, “a lot of it” and “all of it” (your health care services) are two substantially different things. When you start adding up your share of your yearly health care costs, the amount you pay out-of-pocket can be daunting, especially for married couples living on a fixed income. 

When you consider the deductibles, copayments, and coinsurance you are responsible for and then multiply by two, you can easily anticipate how your resources can be severely diminished right before your eyes.

What A Medicare Advantage Plan Is NOT

A Medicare Advantage Plan is NOT Medicare Supplement Plan or Medicare Supplemental Insurance.  Medicare Supplement Plans (sometimes called Medigap) work with Medicare and pay what Medicare does not pay or fill the gaps.

Many people will call anything they have associated with Medicare a supplement, but that is not true.  Medicare Advantage Plans and Medicare Supplements are completely different products.

Medicare Advantage Plans – What Are They?

In very simple terms, a Medicare Advantage plan, although administered by private insurance companies, replaces Original Medicare and provides the same coverage as Original Medicare but with additional covered services. The enrollee will continue to pay their Part B premium and also the additional premium charged by the Medicare Advantage insurance company.

There are, however, many cases when the Medicare Advantage provider does not charge a premium for their services. In these cases, it will depend on the area you live in and the insurance company you choose to do business with.

To join a Medicare Advantage Plan, you must be enrolled in Original Medicare and live in the service area of the company you are applying to. The notable exception is people with permanent kidney failure who generally are not allowed to enroll.

Types of Medicare Advantage Plans?

There are currently six different types of Medicare Advantage Plans and each insurer can offer different coverage as long as they offer the same coverage as Medicare Part A and Part B.

Health Maintenance Organization (HMO)

The HMO is one of the most common types of Medicare Advantage Plans. With an HMO you are restricted to seeing a primary care doctor that is a member of the HMO and in most cases, your primary care doctor must refer you to a specialist if you want and need to see one.

With an HMO, you are typically not covered for health services received outside of your plan’s network except for certain circumstances. This means if you do not follow the rules for services of your plan, you will likely be paying out-of-pocket for services received outside of the network. Although the HMO plans are more restrictive, they are still among the most popular plan because those restrictions are substantially offset by lower plan costs.

Preferred Provider Organization (PPO)

If you join a Medicare Advantage plan that offers services through a PPO, you can generally use any doctor or hospital but will pay much less when you use doctors or hospitals that are members of the plan’s network.

Unlike HMO plans, a PPO typically does not require the patient to get a referral from the primary physician in order to see a specialist. If, however, you intend on seeing a specialist who is not in the network, you will likely be required to pay a higher percentage of the costs.

Even though a PPO plan is far less restrictive when it comes to which doctors and hospitals you can obtain services from, you will generally pay a higher premium as a result.

Private Fee-For-Service Plans (PFFS)

Initially, the PFFS plan was very popular with seniors because it was less restrictive than the HMP or PPO plans. You did not need to choose your primary doctor and in most cases, a referral was not required to see a specialist.

Not having to deal with network physicians and hospitals made this plan one of the most popular until 2011 when Medicare began requiring PFFS plans to implement networks of physicians and medical facilities.

Anytime you are considering a PFFS plan, always make certain in advance that you understand which medical providers you need to use and other requirements in the program.

Special Needs Plans (SNPs)

The SNPs were designed specifically for applicants who qualify because of specialized health needs and who may be in certain living situations such as a nursing home. The plan’s benefits are designed to meet the special needs and conditions of the beneficiaries they serve.

You are typically eligible for an SNP if you have any of the following:

  • A severe or disabling chronic condition like heart failure or dementia
  • You are enrolled in Medicare and Medicaid
  • You live in a health care facility like a nursing home
HMO Point-of-Service

The HMO Point-of-Service plan is a modified traditional HMO. This plan will typically allow you to see a health care provider outside of the network but your out-of-pocket costs will be higher and similar to a PPO plan.

Medical Savings Account (MSA)

MSA plans are not nearly as popular as the others mentioned above. With this plan, you are provided coverage with a very high deductible and a bank account that Medicare will make deposits in throughout the year. It’s important to note that the sum of the Medicare deposits will generally be less than the plan’s deductible so this plan is not a great choice for applicants who need a lot of health care throughout the year.

To Discuss Medicare Advantage Plans Call 844-528-8688

Why Should I Consider a Medicare Advantage Plan?

With any medical insurance, the choice is typically about coverage versus cost. Although you may have to pay an additional premium for your Medicare Advantage Plan, there are several benefits that easily outweigh the additional cost:

  • Medicare Advantage Plans will reduce your out-of-pocket expenses that result from Original Medicare.
  • Most Medicare Advantage plans offer prescription drug coverage (Part D) and also provide dental, hearing, and vision coverage.
  • Some Medicare Advantage plans will pay health care expenses outside the U.S. while Medicare will not.

No matter what your Medicare needs are, We Can Help.  You can reach us by phone 844-528-8688 or by email on our contact us page.  There is never a fee for our services and we carry all the top providers in 43 states.

Frequently Asked Questions

What are the 4 types of Medicare Advantage Plans?

Medicare Advantage plans are generally offered in 4 different options:
1. HMO – Health Maintenance Organization Plans
2, PPO – Preferred Provider Organization Plans
3. PFFS – Private Fee for Service Plans
4. SNPS – Special Needs Plans

Why are Medicare Advantage Plans being pushed so hard?

Medicare Advantage plans (Medicare Part C) are heavily advertised because they provide all of the coverages of Medicare Part A, B, and D, plus additional services like dental, hearing, and vision. Most companies offer a zero-premium plan and other services that seniors can take advantage of.

Can I switch back to traditional Medicare if I do not like Medicare Advantage?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year.

Do I still have to pay Medicare Part B premiums when I am enrolled in a Medicare Advantage Plan?

Yes. Your Medicare Part B monthly premium is still required and will be forwarded to your Medicare Advantage plan insurance company.

Find Your High Quality, Low Cost Medicare Plan Today!

Find Your High Quality, Low Cost Medicare Plan Today!

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.