MEDICARE ADVANTAGE PLANS EXPLAINED
In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network. Except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
Preferred Provider Organization (PPO) plans:
In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) plans:
PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Special Needs Plans (SNPs):
SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
HMO Point-of-Service (HMO-POS) plans:
These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Who can join a Medicare Advantage Plan?
You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan.
How much do Medicare Advantage Plans cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.).
Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D).
In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage. Plan benefits can change from year to year. Make sure you understand how a plan works before you join.
What is a Medicare Advantage plan and what does it cover?
Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. … Your Medicare services aren’t paid for by Original Medicare.
How does Medicare Advantage plan work?
How do Medicare Advantage Plans work? When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering that plan. These companies must follow Medicare’s coverage rules. Medicare Advantage Plans have yearly contracts with Medicare.
What is the advantage of Medicare Advantage?
Medicare Advantage plans can serve as your “one-stop” center for all your health and prescription drug coverage needs. Most Medicare Advantage plans combine medical and Part D prescription drug coverage. Many also coordinate the delivery of added benefits, such as vision, dental, and hearing care.
Is Medicare Advantage better than traditional Medicare?
There is one very important difference between Original Medicare vs Medicare Advantage, however. Medicare Advantage plans have a maximum out-of-pocket limit or MOOP. Once you hit your MOOP, you pay nothing for covered healthcare for the rest of that calendar year.