Medicare Advantage

Medicare
Advantage

Medicare Advantage also known as Part C combines Part A (Hospital Insurance), Part B (Medical Insurance), and sometimes Part D (Drug Coverage) altogether.

These plans are offered by private insurance companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.

Health Maintenance Organization (HMO) requires referrals for specialists by your primary care physician (PCP).

The PCP acts as a gatekeeper to your care. In these plans, you must stay in network (except in an emergency) or else may be subject to full cost for care.

Preferred Provider Organization (PPO) do not require referrals for specialists by your primary care physician (PCP).

These types of plans allow you to see both in network and out of network providers (out of network providers may result in higher copays).

Special Needs Plans (SNPs) provide specialized care for specific groups of beneficiaries, such as those who have both Medicare and Medicaid or chronic medical conditions.

Who Can Join a Medicare Advantage Plan?

To join a Medicare Advantage Plan, you must have both Part A and Part B. You must also live in the plan’s service area and have a valid election period.

How Much do Medicare Advantage Plans Cost?

In addition to your Part B premium, you may have to pay a monthly premium for your Medicare Advantage Plan.

However, it is important to compare the plans with one another to determine which will work the best for you. )

What do Medicare Advantage Plans Cover?

Medicare Advantage Plans must cover all the services that Original Medicare covers except hospice care (Original Medicare covers hospice care).

In every type of Medicare Advantage Plan, you are covered for emergency and urgent care, even outside of the plan’s service area (except for not outside the US).

In addition, many Medicare Advantage Plans offer supplemental benefits.

If your plan also includes Part D, this means the plan will include prescription drug coverage (if you are in a HMO, HMO Point-of-Service Plan, or PPO plan, and you join a stand-alone prescription drug plan you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.