Medicare Advantage
What is Medicare Advantage?
Medicare Advantage (MA) is a type of Medicare plan that is available through private companies that are approved by Medicare.
Often referred to as Part C, they usually include prescription drug coverage and must provide the same Part A and Part B benefits covered by Medicare, subject to deductibles, co-pays and coinsurance.
When you enroll in a Medicare Advantage plan you are no longer covered by Original Medicare, and the private insurance plan becomes your Medicare coverage.
Many MA plans have low monthly premiums and may offer ancillary benefits such as: limited dental, vision, hearing, and gym memberships.
How does Medicare Advantage work?
Unlike Original Medicare, where the government will pay a healthcare provider a fee for service, Medicare pays the Medicare Advantage plan a predetermined fee to administer your Part A and Part B benefits.
When you receive care, you will present your Medicare Advantage insurance card instead of your red, white, and blue Original Medicare card. The healthcare provider will then send the bill to the plan instead of Medicare.
The plans have different networks of doctors and hospitals, and the premiums and out-of-pockets costs - including deductibles, co-payments, and coinsurance can all vary between plans.
Since plan benefits are subject to change every year, you will want to pay close attention to the provider network of any MA plan you're considering and make sure your doctors and hospitals are in-network.
Types of Medicare Advantage Plans
The types of Medicare Advantage plans available will be based on where you live, but the two most common are Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) plans.
Health Maintenance Organization (HMO)
Premiums and out of pocket costs are generally lower with an HMO plan, but the provider network will be more restrictive and you will need to choose a primary care physician (PCP) to coordinate your care. In most cases, the plan will require a visit your PCP and a referral before you will be allowed to visit a specialist.
HMO plans do not typically allow you to go out of network for care, except in cases of an emergency or urgent care.
Preferred Provider Organization (PPO)
With PPO plans, you'll have more flexibility and will be able to visit specialists without referrals. You may also have the option of using out of network doctors and hospitals, but it will usually end up costing you more because there will be higher deductibles, co-pays and coinsurance.
With both PPO and HMO plans, you should carefully review the provider network and confirm that your doctors and hospitals are in-network.