Medicare Advantage Plans
Medicare Advantage Plans are health plans approved by the federal government and run by private companies. These plans are also sometimes referred to as Medicare Part C. Medicare Advantage Plans are not supplemental insurance and must follow rules set by Medicare.
Medicare Advantage Plans will provide benefits at least equal to those in Medicare Part A – Hospital and Medicare Part B – Medical. Medicare Advantage Plans may have different doctor co-payments, hospital coinsurance, and deductibles for than original Medicare coverage. Key differentiators for Advantage plans are the maximum out-of-pocket expenses that could possibly occur in a twelve (12) month period, current doctor’s network and your current formulary of prescriptions supported in the plan. These three (3) areas are recommended to be confirmed before final selection of any advantage plan.
Depending on the plans in your state, some Medicare Advantage plans have a maximum out-of-pocket expense that range from a few hundred to several thousand dollars per year. There is a balance between making sure you are comfortable with your plan and understanding the financial risk versus the lower premiums.
Medicare Advantage Plans might also offer added benefits as incentives, such as some benefits for vision, hearing, dental, and/or health and wellness club membership programs and most will include prescription drug coverage for an additional cost.
Most companies offering Medicare Advantage Plans have automatic claims filing. That means you do not have to worry about filing a claim with the insurance company. With Medicare Advantage claims, your doctor submits an approved medicare service bill to the insurance company, the insurance company checks it against its covered services agreement with medicare, then the insurance company pays the doctor. The services agreement made with Medicare can change each year. It does not have standardized coverage like a Medicare Supplement Plan. Before renewing a Medicare Advantage plan each year, you should check your coverages as per that plan.
Types of Medicare Advantage Plans
- Health Maintenance Organization (HMO) – Offers low to no co-payment for doctor office visits and no deductibles. However, you are required to receive a referral from your Primary Care Doctor before seeing a specialist, and to receive full benefits, you must use doctors and hospitals that are within the provider’s network.
- Preferred Provider Organization (PPO) – These plans also offer low co-payments that are usually slightly higher than those of an HMO. But also allow freedom of choice when choosing a doctor or hospital as long as they are part of their network.
- Private Fee-for-Service (PFFS) Plans – PFFS plans usually offer the most flexibility. As they allow you to choose any doctor or hospital of your choice because there is no provider network. However, your doctor or hospital must accept the plans conditions prior to treating you, except in the case of emergencies.
- Medical Savings Account – This is a very popular option. This plan combines a high deductible health plan with a medical savings account. The government will put money in this account, which you can use to pay your deductible or other out-of-pocket medical expenses such as dental and vision care.
What are the differences between Medicare Advantage Plans and Medicare Supplements?
Medicare Advantage Plans
- Medicare contracts with private insurance companies to administer your Medicare health plan benefits.
- Monthly premiums may or may not be higher that Medicare supplemental plans.
- Some plans will include Medicare Part D prescription coverage.
- Many plans have co-pays for doctor visits, coinsurance per day for hospital stays and other services.
- Typically you are required to see a doctor within a network, unless specifically stated as freedom of choice.
- Premiums can increase each year and co-pays, coinsurance and deductibles can change according to the insurer.
Medicare Supplement Plans
- The government administers Original Medicare health plan benefits and has established ten (10) Medicare Supplement plans designated A through N in all states except for Massachusetts, Minnesota, and Wisconsin. The insurers that provide plans A through N must coordinate payments according to the guidelines of the plans.
- Monthly premiums may or may not be higher than Medicare Advantage plans.
- Prescription coverage is not provided.
- You have the freedom to choose any doctor or any hospital in any state that accepts Medicare.
- Premiums can increase with your age as most plans are based on attained age.
Contact us to learn about the differences in the plans in your area.