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Medicare Advantage 101

Medicare Advantage Plans are a popular alternative to traditional Medicare Supplement Plans.  They are often considered “Part C” of Medicare since they replace the traditional Medicare Part A & Part B.  Want to learn more about the different parts of Medicare? Click:

The Different Parts of Medicare 

Facts about Medicare Advantage (Part C) Plans:old couple at laptop

  • These plans are sold through a private insurance carrier
  •  Plans must cover all of the same benefits as traditional Part A and Part B
  • Some plans also offer additional benefits such as vision, dental or fitness coverage
  • Medicare premiums are still paid and the Medicare Advantage plan may require an additional premium for the plan
  • The Advantage plans will have a deductible and require a copay for services
  • Usually, policy holders will be required to use doctor’s, health care providers and hospitals within the plan’s network.  Services outside of the plan’s network will most often not be covered at all.
  • Plan may require choosing a Primary Care Physician
  • Many plans require a visit to the Primary Care Physician for referrals to specialists
  • Certain services require prior authorization
  • An individual cannot have a Medicare Advantage and a Medicare Supplement plan at the same time
  • A Part D Prescription plan cannot be purchased to help cover prescription costs not covered by a Medicare Advantage Plan

Traditional Medicare consists of Part A which is government sponsored and pays 80%. A Supplement/”Medigap” can be purchased by the individual to act as secondary coverage for the additional 20% of the services provided by Medicare Part A.

The Most Common Types of Medicare Advantage Plans Are:costs benefits buttons

Health Maintenance Organization Plan (HMO)

Usually requires policy holders to utilize the network’s doctors, health care providers and hospitals.

Most of the time prescriptions are covered.

A Primary Care Physician must be designated

Services outside of the network often have to be covered by the policy holder up to 100%

Preferred Provider Organization (PPO)

Any doctor, health care provider, specialist or hospital within the PPO network can be used.

Services outside of the PPO network are often partially covered by the plan.

Prescription coverage is usually included.

In most cases, it is not required to get a referral to see a specialist or get prior authorization for services.

Private Fee-for-Service Plan (PFFS)

Most often any doctor, health care provider or hospital within the PFFS network can be used

Prescription coverage is not always included

Does not require a referral to see a specialist

Often require a copay and coinsurance for certain services

*Something to Consider*

Although Medicare Advantage Plans are far less expensive than Medicare Supplement plans, with Advantage Plans many medical situations may result in high out-of-pocket costs.

In many metro areas there are many different providers who accept these network plans, but particularly in rural areas plan providers may be few and require significant travel.

Plan availability varies by location, often according to zip code or county

Please give us a call or fill out the information request below if you would like more information about Medicare Advantage, help carefully choosing a plan or anything else!

E. Steele

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