A Medicare Advantage Plan (Medicare Part C) is another medicare health plan option offered by private companies approved by Medicare.
Medicare Advantage isn’t supplemental insurance, but completely separate insurance coverage from a private company. When acquiring a Medicare Advantage Plan, remember that it will provide your Medicare Part A and Medicare Part B coverage as well. Advantage plans may include prescription drug coverage as well.
Medicare Advantage Plans are required to provide coverage that meets or exceeds guidelines set by the original Medicare program, but they are not required to cover everything the same way. There are many different kinds of Medicare Advantage Plans:
Health Maintenance Plans: Plans of this type require patients to pick a PCP, or primary care physician, which is the only doctor which can refer you to other medical services. Primary Care Physicians (PCP) are usually general practitioners, family doctors or pediatricians. When your PCP refers you to a specialist, it is almost always a doctor within your network. This is because only specialists that in your network will be covered by an HMO. HMOs provide general care at comparatively lower cost because certain, more expensive, treatments are less likely to be covered. The goal of this type of insurance plan is exclusively maintenance.
HMO Point-of-Service (HMO-POS) Plans: An HMO plan that may allow you to get some services out-of-network for a higher cost. You also do not have to select a primary physician.
(PPO) Plans: Preferred Provider Organizations operate as a network like HMOs, but are generally more flexible. You may visit an out of network provider if the insurance company has not negotiated prices with the provider already. You may be subject to additional fees and co-insurance, or you may need to pay for the treatment yourself and get reimbursed. With PPOs, you there is not a primary physician and no need to receive referrals for special medical services.
PFFS Plans: With Private-Fee-For-Service Plans, Medicare gives out set amount of money to your provider each month and then your insurance company decides how to cover your services. Plans like this may only be available in certain parts of the country where the private companies operate.
SNP: Medicare Special Needs Plans for individuals are plans where certain chronic diseases exist and the patients have persistent special needs. These plans are designed for people who require more Medicare coverage for their specialized needs.
Medical Savings Account Plans: MSA’s are high deductible health plans attached to a bank account. Medicare gives you money through your MSA account, though usually a smaller amount than your deductible. Health care services throughout the year are paid for through your MSA account.
Interesting Stats On Medicare Advantage Coverage:
Enrollment in Medicare Advantage Plans increased from 5.4 million in 2005 to 8.2 million in 2007
As of 2008, 19% of Medicare beneficiaries received Medicare Advantage coverage
1/3 of Medicare recipients receiving Part D coverage are enrolled in a Medicare Advantage Plan
Nearly half (48%) of Medicare Advantage beneficiaries have a household income of less than $20,000
There are many options and it is definitely a good idea to speak with a specialist in the Medicare industry. Medicare can differ greatly between states like Texas and Wisconsin, so speak to a Medicare specialist in your area.
Confused by Medicare and Medicare Advantage Plans? Visit www.easywisconsinmedicare.com for great information on Wisconsin Medicare Plans.
