Medicare Advantage Plans are health
plan options (like HMOs and PPOs) approved by Medicare
and run by private companies. These plans are part of
the Medicare Program and are sometimes called “Part C”
or “MA plans.” Medicare pays an amount for your care
every month to these private health plans. Medicare
Advantage Plans must follow rules set by Medicare.
Medicare Advantage Plans aren’t supplemental insurance.
[For additional information on Medicare
Part C Advantage Plans please consider the following
RESOURCES]
How Do Medicare Advantage Plans Work?
Medicare Advantage Plans provide all
of your Part A (Hospital Insurance) and Part B (Medical
Insurance) benefits and must cover at least all of the
medically-necessary services that the Original Medicare
Plan provides. However, Medicare Advantage Plans can
charge different copayments, coinsurance, and
deductibles for these services. It’s important to call
any plan before joining to find out what your services
will cost and to make sure the plan meets your needs.
Medicare Advantage Plans may offer
extra benefits, such as vision, hearing, dental, and/or
health and wellness programs, and most include Medicare
prescription drug coverage (usually for an extra cost).
Medicare Advantage Plans generally have provider
networks. This means you probably have to see doctors
who belong to the plan or go to certain hospitals to get
covered services. You may need a referral to see
specialists.
If you use providers who aren’t in the network, you may
have to pay the entire cost of the covered service. Some
plans may let you use out-of-network providers,
sometimes for a higher cost. You should check with your
doctors or hospital to find out if they accept the plan.
There are five different kinds of Medicare Advantage
Plans. Most of these plans, like HMOs, have networks of
doctors that see you if you belong to the plan. Others,
such as Private Fee-for-Service (PFFS) Plans, allow you
to go to any doctor if the doctor agrees to accept the
plan’s terms of payment before treating you. There are
also Medicare Advantage Plans called Medicare Special
Needs Plans (SNPs) that serve certain people with
Medicare who are chronically ill, who live in
institutions like nursing homes, or who have other
special needs.
The different benefits offered by the various types of
Medicare Advantage Plans are outlined in the chart that
starts on page 42 in the “Medicare and You” PDF which
can be found at www.medicare.gov.Below is a list of the different kinds of
Medicare Advantage Plans and the page number where you
can find more information about each type of plan. In
all plan types, you are always covered for emergency and
urgent care.
Medicare Advantage Plans include the following:
·Preferred Provider
Organization (PPO) Plans
·Health Maintenance
Organization (HMO) Plans
·Private Fee-for-Service
(PFFS) Plans
·Medical Savings Account
(MSA) Plans
·Special Needs Plans
(SNP)
Cited Source:
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