When it comes to Medicare, there are a lot of options on the table. There is original Medicare, the basic setup of the program, and there are other ways in which beneficiaries can acquire their benefits. One of these ways is the Medicare Advantage Plan, also known as Medicare Part C.
Medicare Advantage Plan provides healthcare insurance within the context of Part C, which was formerly known as Medicare+Choice when it was introduced decades ago. These programs were rebranded as Medicare Advantage plans through the Medicare Modernization Act of 2003, the largest refurbishment of Medicare in the program’s history.
Medicare Advantage Plan coverage is provided by private insurance companies approved by Medicare. Medicare pays the companies to subsequently provide coverage to recipients. Medicare Advantage Plans provide coverage of Part A and Part B insurance.
Types of Medicare Advantage Plans
There are, naturally, different sorts of Medicare Advantage Plan coverage.
- The first is provided by HMOs, or Health Maintenance Organizations. Through most HMO plans, beneficiaries can only attend doctors, hospitals and other health care providers inside a certain network. There may be exemptions in emergencies, but the specifics differ from company to company. Because the private insurance company sets the rules, the details are important.
- The second type of Medicare Advantage Plan coverage available are PPO plans, or Preferred Provider Organization plans. This, again, is a form of Plan C coverage that is bound by networks. In this instance, PPO plan beneficiaries would pay less if they attend a doctor or facility within a network and would pay more when attending a doctor, hospital or facility outside the network.
- Another type of coverage is PFFS coverage, known as Private Fee-for-Service coverage. This coverage enables the carrier to essentially go to any doctor or provider as long as the payment terms of the plan are accepted. This is all determined by the plan, which means it is all determined by the insurance company. Costs and benefits are established, including how much the recipient must pay for care.
- SNPs are Special Needs Plans. This Medicare Advantage Plan coverage is designed for specific groups of people with special needs, of course. This may include people who have chronic health conditions or those residing in nursing homes. It may also provide coverage to people with both Medicare and Medicaid.
- MSA plans, known as Medical Savings Account plans, have a high-deductible health plan coupled to a bank account. In this arrangement, Medicare deposits money into the account and beneficiaries use that money to pay for health care services throughout the year. These plans do not offer drug coverage, which means customers will have to join a Medicare Prescription Drug Plan.
- Finally, HMOPOS plans, also known as HMO Point-of-Service plans, provide out-of-network services for higher copayment arrangements.
Eligibility and Other Facts
Beneficiaries are eligible for Medicare Advantage Plan coverage as long as they live in a qualified service area and possess Medicare Parts A and B. There are always exceptions set up by insurance companies, so check with local carriers to determine basic eligibility requirements.
Premiums are usually administered on a monthly basis for Medicare Advantage Plan coverage. Each plan has different premiums and associated services, so it’s best to compare local plans in order to determine which one provides the best coverage.
Medicare Advantage Plan coverage typically provides for all services of original Medicare coverage save for hospice care. Emergency and urgent care needs are covered under Part C, even outside of the plan’s service area within the United States. Coverage does not extend outside the United States.
Many Medicare Advantage Plan coverage types include extra benefits, like eyeglasses, wellness programs or dental care. Most plans include drug coverage of some type, which means beneficiaries pay a monthly premium for medical and prescription drug coverage.
Remember, benefits can change from year to year!
For more specific information, contact us today. It’s always best to fully understand a plan before signing up, as there can be variables that do not provide all the required coverage and costs can be quite high.