What are Medicare Advantage Plans?
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.
Types of Medicare Advantage Plans
· Health Maintenance Organizations (HMOs)
· Preferred Provider Organizations (PPOs)
· Private Fee-for-Service plans (PFFS)
· Special Needs Plans (SNPs): For people who have a chronic or disabling condition such as diabetes, COPD or congestive heart failure. SNPs may also be available to people who also receive Medicaid and who live in care facilities like nursing homes.
· Medical Savings Accounts
Qualifying for a Medicare Advantage Plan
To qualify for a Medicare Advantage plan you must meet these requirements:
Live in the plan’s service area
Be enrolled in both Medicare Part A and B
Don’t have end-stage renal disease (ESRD).
Continue to pay your Part B premium in addition to any premiums the plan may charge.
Some people believe if they have a Medicare Advantage plan they no longer have Medicare, this is not true.
How are Medicare Advantage Plans different from Original Medicare?
More Coverage: In many cases Medicare Advantage plans will offer above and beyond what Original Medicare offers for benefits, such as vision, dental or hearing services and use of fitness facilities. Co-pays, benefits, premiums, and costs can vary greatly between the plans. It is important to review your Medicare Advantage plan every year to be sure you are receiving the best coverage for your needs.
Maximum Costs: Medicare Advantage plans also have a maximum out of pocket limit unlike Original Medicare.
Drug Plans: Prescription drug plans are embedded into many of the Medicare Advantage Plans so you do not need an additional drug plan. You will want to make sure that your prescription drugs are in the plan’s drug formulary (drug list).
Networks: Most Medicare Advantage plans have networks that you must use to receive your services (like doctors, hospitals, or pharmacies). If you use a service outside of the plan’s network, there can be additional costs. When finding a plan to fit your needs you will want to check if your doctor(s) is in the plan’s network. Keep in mind there is no guarantee your doctor will stay with the Medicare Advantage plan you choose for the entire year.
Medicare Savings Programs
There are additional programs available that help people with Medicare who have limited income and resources. These programs can help pay for Medicare Part A and B costs, such as premiums, deductibles, and copayments. If you have Medicare and full Medicaid coverage, most of your health care will likely be covered. There are different levels of assistance depending on your income and resources. Contact your local or state Medicaid office to see if you qualify and to apply.