Medicare Advantage insurance
Medicare Advantage insurance Plans are health insurance plan options approved by Medicare (2006) and offered by private companies. These insurance plans are part of Medicare and are sometimes called “Part C”, “Medicare C”, “MA or MAPD Plans”. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans and then these plans are responsible for your claims previously sent to Medicare. These companies must follow rules set by Medicare and are supervised by them. These plans have no health underwriting and you can normally change plans annually if you choose. You can also return to Medicare annually if you desire. Caution: if you leave your Medigap insurance Plan for an Advantage insurance Plan and you are gone for more than 12 months and want to return to your Medigap insurance plan, you may not be able to because of health underwriting requirements.
Medicare Advantage insurance Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren’t supplemental insurance.
Not all Medicare Advantage insurance Plans work the same way, so find out the insurance plan’s rules before joining. See the Resources Tab and “Medicare Explained” for an outline of these various insurance plan rules. They are insurance required by Medicare to cover the same or better than Medicare. Obviously, to be attractive to you, they always cover better than Medicare. Not all insurance plans are available in all insurance areas of a state. They vary by county.
Medicare Advantage insurance Plans include the following:
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Private Fee-for-Service (PFFS) Plans
- Medical Savings Account (MSA) Plans
- Special Needs Plans (SNP)
Note: There are other types of Medicare Advantage insurance Plans that may be available; however, they are less common. Provider Sponsored Organizations (PSOs) are insurance plans run by a provider or group of providers. In a PSO, you usually get your health care from the providers who are a part of the plan. Religious Praternal Benefit (RPB) Plans are offered to members of certain religious groups. RPB’s can be any plan type, including an HMO or PPO.
Medicare Advantage insurance Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually copayments but can also be coinsurance and deductibles. It’s important to call any plan before joining to find out the plan’s rules, what your costs will be, and to make sure the plan meets your needs.
Medicare Advantage insurance Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage. You may need a referral to see specialists. Some Medicare Advantage Plans have provider networks. In some cases this means you can only see doctors who belong to the plan or go to certain hospitals to get covered services (other than for emergency or urgently needed care or medically-necessary dialysis).
In some plans, if you see a doctor or other provider who doesn’t contract or participate with the plan, your services may not be covered at all, or your costs will likely be higher. You should check with your doctors or hospital to find out if they accept the insurance plan.