A Medicare Advantage Plan is another plan choice you may have as part of Medicare. These plans, sometimes called ‘Part C’ or ‘MA Plans,’ are offered by private insurance companies approved by Medicare. The premiums are a flat rate, regardless of age.
If you join a Medicare Advantage Plan, it will provide:
- Medicare Part A (hospital insurance) coverage
- Medicare Part B (medical insurance) coverage
- Limits on the out-of-pocket costs you pay
- Medicare prescription drug coverage (Part D)
- Provider networks to help manage costs
- Extra coverage, such as vision, hearing, dental, and/or health and wellness programs
In all types of Medicare Advantage Plans, you’re always covered for:
- Emergency and urgent care
- Hospice care (covered by Original Medicare)
Plans can charge different copays, coinsurance, and deductibles for these services.
Depending on the Medicare Advantage Plans offered in your area, you may have these options:
HMO – Health Maintenance Organization
In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. You may also be required to get a referral from your primary care doctor prior to visiting a specialist.
HMO-POS – HMO Point of Service Plan
This is an HMO Plan that allows you to get some services out-of-network for a higher cost.
PPO – Preferred Provider Organization
In most PPOs, you pay less if you use doctors, hospitals, and other health care providers that belong to the Medicare Advantage plan’s network. You can use doctors, hospitals, and providers outside of the network but you may pay higher copays and coinsurance.
PFFS – Private Fee for Service
PFFS plans are like Original Medicare in that you can generally go to any doctor, other health care provider, or hospital if they agree to treat you. The Medicare Advantage Plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
SNP – Special Needs Plan
SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
- MSA – Medical Savings Account
This is a plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
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