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 Medicare Advantage Plans
Medicare Advantage Plans are health plan options that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C”. When you join a Medicare Advantage Plan, you are still in Medicare. In many cases, the premiums or the cost of services (co-pays or co-insurance) can be lower in a Medicare Advantage Plan than they are in the Original Medicare Plan or Original Medicare with a Medicare Supplement policy.
Medicare Advantage Plans provide all of your Medicare Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. The Advantage plans pay instead of, not after Medicare. They generally offer extra benefits that may include routine physicals and preventative care, dental, hearing, and eye care. Many plans include Part D drug coverage.
Medicare Advantage plans include:
- PFFS – Private Fee for Service plans
In most cases, you may go to any Medicare-approved doctor or hospital that accepts the plans payment terms and conditions for covered services.
- PPO – Preferred Provider Organization plans
PPOs have a network of doctors and hospitals. You can also use out-of-network providers for covered services - usually for a higher cost.
- HMO – Health Maintenance Organization plans
Generally you must get your care and services from doctors or hospitals in the plan’s network (except emergency or urgent care).
- Special Needs Plans
These are plans specially designed for people with certain chronic diseases, special health needs, or Dual (Medicare-Medicaid) eligibility. These plans can be designed as PFFS, PPO, or HMO plans and they often offer extra benefits based on the chronic disease, special health need, or provide benefits not available with Medicare and/or Medicaid.
To join an Advantage plan, you must have Medicare Part A & Part B, live in the service area and for most plans, not have End Stage Renal Disease (ESRD - Kidney disease). ESRD may be covered in a Special Needs Plan for chronic diseases.
Your Medicare decisions are important because they affect things like how much you pay and what is covered. Before making any decisions, learn as much as you can about the types of plans and coverage available to you. Work with someone who is experienced in the Medicare market and is certified to discuss the Advantage plan(s) you are considering. It is one of the best ways to get the information you need.
At OFM, we have that experience, knowledge and certification(s). Let us help you make the right decisions about Medicare Advantage coverage.
To receive a quote on available Medicare Advantage Plans, click here.
If you would like to speak to an OFM Benefits Consulting representative about Medicare Advantage Plans, click here or call 888-293-7923. |
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