Medicare Advantage

MEDICARE ADVANTAGE PLANS

Also known as “Medicare Part C” or “MA Plans”, take the place of original Medicare Part A (Hospital Insurance), Part B (Medical Insurance) and Part D (Prescription Drug coverage). Thus, Medicare Advantage plans are usually referred to as an “all in one plan”. Medicare Advantage plans are sold by private insurance companies that have an annual Medicare contract.

There are different kinds of Medicare Advantage plans such as:

  • Health Maintenance Organizations (HMO’s)
  • Preferred Provider Organizations (PPO’s)- Most plans in Southeastern NC are PPO’s
  • Private Fee-for-Service plans (PFFS)
  • Medicare Medical Savings plans
  • Special Needs plans
    • Chronic Needs plans
    • Dual Eligible (Medicare and Medicaid)

CHARACTERISTICS OF A MEDICARE ADVANTAGE PLAN:

  • Medicare pays the Medicare Advantage companies a certain amount of money every month to provide your care. In turn, the Medicare Advantage companies must follow rules set forth by Medicare.
  • If you choose a Medicare Advantage plan, you agree to receive your hospital and medical benefits according to the rules of the Medicare Advantage plan.
  • Medicare Advantage plans offer the same basic benefits as Medicare but may have different out of pocket costs such as copays, deductibles and coinsurance. For instance, one plan may have a $20 copay for a doctor’s visit while another plan may have a $0 copay.
  • A Medicare Advantage plan may change its rules and benefits from year to year.
  • Some Medicare Advantage plans have zero premiums with copays and coinsurance while others may charge a premium but have $0 copays and varying coinsurance.
  • Most plans offer prescription drug benefits. If they don’t, you would need to purchase a separate Medicare Part D prescription drug plan.
  • Medicare Advantage plans offer extra benefits on top of traditional Medicare such as Dental, Vision, hearing aids and more.
  • Some Medicare Advantage plans may pay a certain amount (ie. $50) of your Medicare Part B premium for you.
  • Medicare Advantage plans may impose their own rules on how to receive your medical care. For example, they may require that you go to a certain set of doctors in a network or obtain a referral to see a specialist.
  • Medicare Advantage plans vary within a state. If you move to another state or perhaps even another county, you would need to choose a plan that operates in that area.
  • A word of caution: if your Medicare Advantage plan has a prescription benefit and you purchase a Part D prescription plan, you will be automatically disenrolled from your Medicare Advantage plan and placed back on original Medicare.

Questions or would like further information?  Please feel free to call me at (910) 775-0700 for a FREE consultation!