Medicare Advantage

(Part C)

What are Medicare Advantage Plans?
Medicare Advantage (also known as Part C)  is another way to get your Part A and Part B coverage.
Medicare Advantage Plans are offered by Medicare-approved private companies that must follow rules set by Medicare.
Most Medicare Advantage Plans include drug coverage (Part D).  In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs.

What should I know about Medicare Advantage Plans? 
To join a Medicare Advantage Plan: You must have Part A and Part B and you must live in the plans service area.
What are the different types of Medicare Advantage Plans?
There are several types of plans. The most commonly known plans are HMO, PPO, PFFS and SNPs.
Health Maintenance Organization (HMO) – This is a popular managed care plan that contracts with doctors and providers in your area. You will need to select your primary care physician and need a refferal to see a specialist in network. Some plans offer premiums as low as $0 monthly. In general, you must get your care from the providers that are in the plan’s network, except for in emergency situations.
Preferred Provider Organization (PPO) – This type of plan also has a network of health providers.  However you are not required to choose a primary care physician and do not need a refferal to see a specialist.  PPO plans offer flexibility by giving the member more freedom to see doctors out of network, generally at a higher cost.
Priviate Fee for Service Plan (PFFS) – A Medicare PFFS plan is another type of Medicare Avantage plan that is offered in select areas.  With this type of plan, you agree to pay the plan’s premiums, co-pays and coinsurance for services that are outlined in the plan.  It’s different from an HMO or PPO plan because you are not limited to a network of providers. However the provider must agree to accept the plan’s payment terms and conditions before assisting with your care.
Special Needs Plans (SNPs) –  Are types of Medicare Advantage plans that provide managed care to beneficiaries with specific conditions and illneseses. These health conditions include and are not limited to cancer, chronic illnesses and chronic heart failure.  SNP plans are also designed for enrollees that are eligible for both Medicare and Medicaid.

What do Medicare Advantage Plans Cover? 
Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers.
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover such as:
Dental, Vision, Hearing, Fitness Programs, Transportation and over the counter drugs.
Some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees.
It’s always important to check with the plan to see what benefits it offers, any limitations and to see if you qualify.

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