Understand Medicare Advantage

A Medicare Advantage plan, similar to a PPO or HMO or PPO, is a type of Medicare plan made available to Medicare participants. This option is also known as Medicare Part C. These plans are offered by private health insurance companies approved by Medicare.

Medicare Advantage (formerly Medicare + Choice) is a program that allows the Medicare population to receive benefits with private insurance. The government pays insurers a certain amount to cover part of the plan, while insurers can offer a range of other benefits under the rules set by the Medicare and Medicaid Solutions Center. In many cases, the coverage of prescription drugs (Medicare Part D) is included in the Medicare Advantage plans.

Types of plans

Preferred Provider Organization (PPO): Some Medicare Advantage plans sign contracts with a network of health care providers (eg, doctors, hospitals) and charge fewer fees when subscribers use services from these providers. Plan participants can use external providers for additional costs.

Health Management Organization (HMO): HMOs also have a network of pre-approved service providers that are covered in your plan, but the main difference is that you need to choose a family doctor. This family doctor acts as your personal physician, but also as your health coordinator. If you ever wanted to see a specialist who was not in your HMO plan network, your family doctor could offer you a referral if he thinks it is necessary. With this transfer, your insurance will pay part of the cost, but without it you can expect to pay the full price.

Private Fee-for-Service (PFFS): PFFS plans behave in a similar way to traditional Medicare as it allows you to visit any provider who accepts the payment arrangements in your plan. Sometimes these plans set up network of providers for certain categories of services, but allow you to see someone outside the network who accepts payment of the plan.

Special Needs Plan (SNP): Special needs plans are available for members of the population eligible for Medicare who are also eligible for Medicaid, institutionalized, or suffering from a chronic disease.

Savings Accounts for Medicals (MSA):  Savings accounts for Medicals, because they have a high deductible, usually do not require a premium. Participants must pay the Medicare Part B premium and pay for Medicare-covered services, and once a participant reaches the deductible, the plan will pay for Medicare services. Medicare also deposits money in a savings account to pay medical expenses. MSA plans do not include prescription drugs, but a separate prescription drug plan can often be purchased.

Medicare benefit is beneficial because it usually does not require the purchase of a Medicare Supplement plan and usually offers additional benefits such as dental and vision or “wellness” benefits like discounted gym membership. Participants who choose to take Medicare Advantage will retain the full protection of regular Medicare patients and reserve the right to petition the Center for Medicare and Medicaid services.

When you receive offers for a Medicare Advantage plan, it is usually best to work with a company or agency that has access to more than one insurer. This way, you can get a bundle of quotes to determine which one works best for you.