What is Medicare Advantage?
Medicare Advantage is also known as Medicare Plan C. It’s a bundle package.
What are the benefits of enrolling?
Medicare Advantage may be the right option for you because:
- It combines Original Medicare to merge it with the Medicare prescription drug plan.
- You not only receive the benefits of Original Medicare – you get all of it and more.
- You can get dental, vision, and hearing with certain Medicare Advantage Plans (the extent of how many additional benefits you receive will depend on the Medicare Advantage Plans available to you in your area).
- Medicare Advantage may even reduce costs on your Part B premium.
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What should I know?
Before enrolling, you should know:
- You have to have Medicare Part B. You also must continue to pay your Medicare Part B premium. You cannot drop Medicare Part B when you have Medicare Advantage.
- You have to get care in facilities that accept Medicare Advantage (as opposed to getting care in any hospital that accepts Medicare, like in the case of Original Medicare).
- You may be mandated to choose a primary care physician in your network.
- You might have to get a referral from your primary care physician before you can see a specialist.
- You will not be able to purchase a separate form of insurance coverage (e.g., Medicare Supplement Plans or health insurance from your employer).
What do the Medicare Advantage Plans consist of?
Medicare Advantage has different forms. There are different types of Medicare Advantage Plans, and your area’s network may influence what specific benefits are available to you. Here are the types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- HMO-Point of Service (HMO-POS)
- Medicare Medical Savings Account (MSA)
Here are the features of each:
- HMO – Most affordable; you must choose your own primary care doctor. You will need that doctor’s referral to see a specialist. Your treatment is not covered if you go outside of the network.
- PPO – No need to choose a primary care doctor. No need for a referral. You can also seek care outside of your network (at a higher cost). Has an out-of-pocket limit of $6700 in 2020. Once that is paid out-of-pocket, your Medicare Advantage provider will take care of the rest.
- PFFS – No need to choose a primary care doctor and no referrals required for seeing specialists.
- HMO-POS – Similar to HMO, but with this hybrid, you can reap the HMO benefits while also being able to get treatment outside the network (which will be at a higher cost).
- MSA – Offers a high deductible option and a savings account that helps pay for your healthcare costs.
If you have any questions about Medicare Advantage, call us today.
