What are Medicare Advantage Plans
Your Medicare Advantage Specialist
There are many different Medicare Advantage plans available. It can be confusing to know the ins and outs of these different plans. Is an HMO or a PPO plan better for me? Well that depends! We will meet with you one-on-one and ask the RIGHT Questions to match you up with the RIGHT PLAN. Our consultative approach eliminates the needs to SELL SOMETHING and helps you get THE RIGHT FIT!
At Lets Talk Medicare, we are contracted with ALL the Medicare Advantage Plans so we can help you sort out the Differences and then enroll YOU!
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Medicare Advantage Explained
A Medicare Advantage plan is a private health insurance plan approved by Medicare. You may opt to get your Part A, B and D benefits from a Medicare Advantage plan instead of traditional Medicare. Originally called Part C, these Medicare private insurance plans usually have an HMO or PPO network of doctors.
Medicare Advantage plans were created as an alternative to Original Medicare and Medigap. By joining one of these plans, you direct Medicare to pay the Advantage plan a set monthly amount for your care. In return, the plan will deliver all of your Part A & Part B services. They take on all of your medical risk.
You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan. You must be enrolled in both Medicare Parts A and B and live in the plan’s service area.
Medicare Advantage policies are NOT Medigap plans. They work differently because they pay instead of Medicare, not after Medicare.
Whats included in a Medicare Advantage Plan
Medicare Advantage Plans include Part A, Part B, and usually Part D (Medicare prescription drug coverage).In addition to covering everything that’s included in Medicare Part A and B, Medicare Advantage Plans generally offer additional coverage, including dental, hearing, vision, Medicare Prescription Drug coverage, and other health and wellness services through an HMO or PPO network of heath care providers.
You can go to any hospital, doctor, or health care provider in your network’s plan. Depending on which plan you choose, you may also be able to go to those who are out-of-network.
Is there a monthly premium? There may (or may not) be a monthly premium for your Medicare Advantage plan in addition to your Part B premium. Prices will vary depending on the type of plan you choose.
Watch this Easy to Understand Video about Medicare Advantage
For a complete list of all plans available in a certain zip code go to www.medicare.gov
Types of Medicare Advantage Plans
HMO (Health Maintenance Organization) Plan:
All of your health and wellness services (with the exception of emergency care, out-of-area urgent care, or out-of-area dialysis), will generally go through a primary care physician along with any hospitals and/or specialists that is in your plan’s network. (If you see someone outside of this network, you may be responsible for the full cost of service/treatment.)
PPO (Preferred Provider Organization) Plan:
although you will generally pay less if you go to a doctor, hospital, or other health care provider in your plan’s network, you have the option of going to an out-of-network provider. You do not need to choose a primary care physician, and, in most cases you do not need a referral to see a specialist.
PFFS (Private Fee-For-Service) Plans:
you can generally go to any Medicare-approved doctor, hospital, or health care provider who accepts the plan’s payment terms and agrees to treat you. If your PFFS plan has a network, you can see any in-network provider or out-of-network provider who has agreed to treat plan members. Some PFFS Plans do NOT include prescription drug coverage. If not, you may need to purchase a Medicare Prescription Drug plan.
For more on PFFS plans click here:
SNP (Special Needs) Plan:
this is for people who require specialized health care, such as those who live in a nursing home, have chronic health conditions, or who are on both Medicare and Medicaid. You will generally need to select a primary care physician who can refer you to a specialist in the network, if/when one is needed. Medicare Prescription Drug coverage is included in this plan.
To find out more about Special Needa Plans visit our Blog Posts.
Medicare Advantage Plans usually contain Prescription Drug Coverage If you enroll into a Standalone Medicare Prescription Drug plan while you are enrolled in a Medicare Advantage Plan it will dis enroll you from Your Medicare Advantage Plan and put in back into Original Medicare.