Basics of Medicare Advantage Plans

Medicare Advantage the Basics

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Medicare Advantage Plans, also known as MA Plans or Medicare Part C is a managed health care program adminstered through a private insurance company. It is known for it’s low upfront costs. In fact, many areas of the country offer zero premium plans. With zero premium plans you pay nothing upfront.

Some Medicare Advantage Plans will offer prescription drug coverage. This type of plan is called an MAPD. Other Medicare Advantage Plans may offer additional benefits, such as dental and vision.

Medicare Advantage is Not Original Medicare

Instead of receiving Part A and Part B benefits from Original Medicare, with a Medicare Advantage Plan your benefits are administered by a private insurance company. The companies and their plans are approved by the federal government to provide the equivalent of Part A and Part B benefits to its enrollees. As mentioned earlier, some of these Medicare Advantage Plans will also offer additional benefits. You remain in Medicare while receiving these benefits, but Medicare now pays a private company to administer them.

Medicare Illustration
Medicare Advantage Illustration

Most Common Types of Medicare Advantage Plans

Not all Medicare Advantage Plans work the same. All of them have networks with the exception of Private Fee For Service (PFFS) plans. It is important to understand your plans network and its restrictions.

Health Maintenance Organization (HMO)

With HMO’s, you are required to use doctors, hospitals and other healthcare providers in their network with some exceptions.

In most cases, you will need to choose a Primary Care Provider (PCP) with an HMO. Any care given by a specialist will require a referral.

Private Fee-for-Service (PFFS)

With most PFFS plans, you are free to use any doctor or hospital that accepts Medicare and the PFFS terms of service.

Preferred Provider Organization (PPO)

PPO plans have network doctors, hospitals, and other healthcare providers.

With a PPO, in most cases, you can receive out-of-network care, but at a higher cost.

Medicare Advantage Pros and ConsMedicare Resources Icon

Medicare Check MarkLow Upfront Costs

Medicare Check MarkAnnual Maximum Out-of-Pocket Expenses

Medicare Check MarkMost Plans Offer Drug Coverage

Medicare Check MarkMany Plans Offer Dental and Vision Benefits

Medicare Check MarkYou Can Switch Plans Each Year with No Underwriting

Red Check in CircleUnpredictable Costs Like Copays and Deductibles

Red Check in CircleNetwork Restrictions Without Nationwide Coverage

Red Check in CircleSpecialists Require Referrals with HMO Plans

Red Check in CircleYour Plans Benefits Can Change Each Year

Buying a Medicare Advantage Plan

There are only certain times per year known as enrollment periods when you can purchase a plan. Speak with one of our agents about your eligibility.

Medicare Advantage plans can be attractive because they have low or in some case zero premiums. Make yourself aware of potential hidden costs that can cause unanticipated medical expenses. All Medicare Advantage Plans have a maximum out-of-pocket limit. This amount cannot exceed $6,700 a year in 2017.

Be sure you understand all the benefits. Does your plan have prescription drug coverage? What are the annual deductible and out-of-pocket limits? Are there network restrictions?

Because Medicare Advantage plans are not standardized like Medicare Supplements, they harder to compare. There are also strict rules set by the insurance company that you must adhere to when using your plan. The rules vary by company, and type of plan. Be sure to familiarize yourself with any restrictions before purchasing.

Medicare Advantage plans are not for everyone, but if upfront cost is your primary concern, it could be the best option. Before making a final decision, Medigap Planners highly recommends speaking with one of our licensed agents. We can help determine your eligibility and needs. We will also explain other low-cost options that offer comprehensive health insurance coverage.