Medicare Advantage Plans

What is a Medicare Advantage Plan

Medicare Advantage PlansA medicare advantage plan refers to medical and hospital insurance for the elderly or other Medicare-eligible persons that is offered by private companies as opposed to the federal government. These private companies are paid by Medicare in order to cover your medical benefits. A medicare advantage plans also referred to as “part C” plans provide the same Medicare part A (Hospital Insurance) and Medicare Part B (Medical Insurance),with the exception of hospice care.  Please be aware, a Medicare Advantage Plan is not a Medicare Supplement or Supplemental Insurance.

Different Types of Medicare Advantages Plans.

Medicare Advantage plans come in different forms and types; benefits also vary according to the individual plans. The different types of Medicare Advantage plans include:

  1. Health Maintenance Organisation. (HMO)

    In HMO plans, patients are only required to visit doctors, healthcare providers, and hospitals that are contained in the plan’s network with the exception of during emergency or urgent situations.  Most importantly, you need a referral from your primary healthcare provider for tests or to see other specialists or doctors.

  2. Preferred Provider Organization Plans (PPO)

    Patients covered in the PPO plan usually pay less when they visit hospitals, specialists and other healthcare providers that are covered in the plan’s network. On the other hand, when they visit specialists, hospitals and healthcare providers outside of the network, they are required to pay more.

    3.Private Fee-for-Service Plans (PFFS)

    PFFS plans are very similar to original Medicare; whereby one can visit any specialist, hospital and healthcare provider as long as they accept the payment terms contained in the plan. This plan will normally have set a predetermined pay rate for specialist, hospitals and healthcare providers as well as how much one is required to pay to get medical care.

    4.Special| Needs Plans (SNPs)

    SNPs provide cover for people requiring specialized and focused healthcare such as those having both Medicaid and Medicare, living in nursing homes, or suffering from chronic medical
    conditions.

    5.HMO Point-Of-Service Plans (HMO/POS)

    HMO plans allow patients to seek some services outside the confines of the plan’s network for a higher coinsurance or copay.

    6.Medicare| Savings Account Plans (MSA)

    In the MSA plan, a bank account is combined with a high-deductible health plan. In the MSA plan, Medicare normally deposits a certain amount of money into the account, out of which you can use to pay for your health care throughout the year. Typically, MSA Plans don’t usually cover for prescription drugs; this can only be taken care of by joining a Medicare Prescription drug Plan.

What is Covered by Medicare Advantage Plan?

First and foremost Medicare advantage plan covers all the services that the Original Medicare covers apart from hospice care. Additionally, medical advantage plans offer urgent and emergency care coverage outside of the plan’s network area but not outside the USA.

In addition to your Medicare part B premium users of Medicare Advantage plan are also required to part with a single monthly charge to cater for medical and prescription drug coverage. Medicare Advantage plans will also generally cover Medicare Part D (prescription drug) as well as other benefits such as dental, travel coverage, wellness benefits, and vision coverage.

Who is Eligible to Join a the Medicare Advantage Plan?

For you to be eligible for enrollment in the Medicare advantage plan one needs to have already subscribed for Medicare Parts A and B. Additionally, you must live within the plan’s service areas and should not have been diagnosed with End-Stage Renal Disease or permanent Kidney failure.

Medicare What is a Medicare Advantage PlanAdvantage plan can only be joined at certain times of the year ie. from October 15 December 7th. Enrollment into the plan is also available when you qualify for a special election period or when you first join the Medicare program.

Advantages of the Medicare Advantage Plan.

So, is the Medicare Advantage plan the right one for you? In order to answer this question, you have to consider your particular situation as well as the specific plan than you are looking to enrolling.
The following are some of the advantages of the Medicare Advantage plan that you need to know about:

  1.  Some private insurance companies offer $0 premium cost for their Medicare Advantage plans. Such Medicare Advantage plans will be dependent upon the state or county in which you reside.
  2.  Medicare Advantage plans generally offer other additional benefits over and above those offered by original Medicare eg. Dental or vision coverage.
  3.  Each Medicare Advantage plan offers a maximum out-of-the-pocket limit of how much money you can spend on health care each year. If this limit is reached, the patient does not pay any more additional costs for the covered services.