MEDICARE ADVANTAGE PLANS


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Medicare Advantage Plans are health plans that are approved by Medicare and provided by private companies. Medicare sets the rules for Medicare Advantage Plans and regulates the private companies who operate the Plans.

Medicare Advantage Plans are also sometimes referred to as Medicare Health Plans, Medicare Part C Plans, and MAs/MA-PDs (and originally, Medicare Advantage Plans were called Medicare+Choice plans). A Medicare AdvantagePlan combines your Medicare Hospitalization (or Medicare Part A) and Medical insurance or Doctor’s Visit Coverage (or Medicare Part B) into one Health Plan that provides the same Medically-Necessary Services as Original Medicare. Some, but not all Medicare Advantage Plans also offer Prescription Drug Coverage (or Medicare Part A and Medicare Part B and Medicare Part D) at no additional cost and are called MA- PDs.

What are the types of Medicare Advantage Plans?
There are only a few primary types of Medicare Advantage Plans and most of the different Medicare Advantage Plans may also include prescription drug coverage:

  • Health Maintenance Organization (HMO) – A Health Maintenance Organization that is contracted with Medicare provides you with access to a network of doctors and hospitals that coordinate your care, with an emphasis on prevention.
  • Health Maintenance Organization with a Point of Service Option (HMO POS) – This is a Health Maintenance Organization that provides a more flexible network allowing you to seek care outside of the traditional HMO network under certain situations or for certain treatment.
  • Preferred Provider Organization (PPO) – A Preferred Provider Organization provides access to a network of doctors and hospitals that coordinate your care.
  • Private Fee-For-Service (PFFS) – A Private Fee-For-Service Plan is a type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts both Medicare and the plan’s payment (or terms and conditions).
  • Medicare Special Needs Plans (SNPs) – A Special Needs Plan is a Medicare Advantage Plan with coverage designed especially for Medicare beneficiaries with certain chronic conditions (like Diabetes) or have some other specific need.
  • Medicare Medical Savings Account (MSAs) – A Medical Savings Account is a combination of a high-deductible health plan and a bank account where your Plan deposits a certain amount of money per year.

How does a person choose a Medicare Advantage Plan?
It is of course important to compare the benefits between your current coverage and the Medicare Advantage Plan. Be sure that you understand the additional benefits and any benefits (or freedoms) that you may loose. In general, we usually remind people to look at the Cost, Coverage, Convenience, Company reputation, and Comments from other Members. In particular, be sure to look at the following:

  • Can you change your current doctor(s) or are they in the new plan’s network?
  • If prescription drug coverage is provided, are your medications on the plan’s formulary?
  • How much is the monthly premium?
  • How much will your coverage cost? Co-payments and co-insurance as explained in the plan’s Summary of Benefits. Which additional services are offered, such as preventative care, vision, dental, and health club membership.
  • Are there any treatments that you need that are not covered by the Plan?
  • Can you work within the network restrictions (like paying extra when you visit a doctor who is out-of-network)?
  • Be sure to give us a call to find out what great products and carriers we have for you and your clients!

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