Medicare Advantage Plans are the part of an arrangement made by the US government which allows you to get your Medicare benefits through Original Medicare. The charges of Medicare benefits are paid by the government when you get them if you already have Original Medicare. The private companies permitted by Medicare offer Medicare Advantage Plans or Part C to their employees to avail Medicare benefits and to cover these benefits Medicare pays the companies offering these plans.
An Advantage Plan will offer you all of your Hospital insurance coverage under Part A of Medicare and Medical Insurance coverage under Part B when you join it. These options make the Medicare Advantage plans differently from Medigap or Medicare Supplement Insurance plan.
Types of Medicare Advantage Plans
Medicare Advantage plans are of various types
HMO or Health Maintenance Organization plan: This plan allows you to go to the healthcare providers including doctors and hospitals in the network of this plan, except for an emergency or urgent circumstance. However the specialist or the doctors will see you or perform tests on you only when the primary care provider of your area has given you a referral.
PPO or Preferred Provider Organization Plan: This plan allows you to use the services of hospitals and doctor in its network and pay a lesser amount of money but you will have to pay more if the doctor or health care provider is from out of the network.
PFFS or Private Fee-for-Service plan: Like Original Medicare this plan allows you to use the services of any healthcare provider, doctor or hospital until the payment terms of this plan is accepted by them. The amount to be paid to the health care providers by you and by the Medicare will be determined by this plan in a transparent manner.
SNP or Special Needs Plan: The specialized and focused healthcare services provided to certain groups of people including people having Medicaid and Medicare both, having medical conditions of chronic type or living in a nursing facility will be covered under this plan.
HMO-POS or HMO Point-of-Service plan: This plan will permit you to get some of the medical services out-of-network healthcare providers on the basis of coinsurance or a higher copayment.
MSA or Medical Savings Account plan: In this plan, a bank account is combined with a high-deductible health plan. In this bank account money, below the amount deductible, is deposited by Medicare so that you can use it throughout the year to pay for the medical services you have availed. However, no Medicare Drug coverage is provided in this plan. You must join a plan of Medicare Prescription Drug to get this drug coverage.
Advantage Plans are for whom
You can be eligible to join Advantage Plans if you have Part A and B of Medicare and line in the service of the plan. These plans cannot be joined by the people suffering from the problem of permanent failure of kidney or Renal Disease of end-stage.
Cost of Medicare Advantage Plans
You must pay the premium of the services provided in an Advantage Plan for one month along with the premium of Medicare Part B. The costs of services and premiums of each Advantage plan are different. So before joining any of these plans, you will have to compare the plans and their costs.
Coverage of Advantage Plans
Apart from hospice care, all the services covered by Original Medicare must be covered by Medicare Advantage plans. Even if you join an Advantage Plan you can avail the coverage of hospice care under Original Medicare. You are always covered for urgent and emergency care under all the Advantage Plans. Most of the Medicare Advantage Plans offer additional benefits like eyeglasses, wellness issues or dental care but they should also provide emergency coverage out of their service area within the US. They also include coverage of Part D i.e. Medicare for prescription drug coverage but to avail this coverage you must pay the premium of the plan for a month along with the premium of Part B.
But before joining any of the Advantage Plans you must understand their working as the costs and benefits of these plans can change on a yearly basis.
Working of Advantage Plans
An alternative to Original Medicare is Medicare Advantage Plans which are also known as MA Plans’, All in One’ or Part C’. The companies authorized by Medicare offer these plans to their employees. You are still linked with Medicare when you join any of these plans. The plans bundled in the Advantage Plans may include Part A, Part B and Part D of Medicare that covers hospital and medical insurance respectively along with coverage for drugs.
Services covered in Advantage Plans
All services provided by Medicare are covered in Medicare Advantage Plans. Services like hearing, dental and vision are additionally covered by some of these plans.
Rules for Medicare Advantage Plans
Every month a fixed amount is paid by Medicare to the companies providing plans of Medicare Advantage. Some of the rules designed by Medicare have to be followed by these companies.
The costs paid from your pocket can be different for each Advantage Plan. Their rules to get services can also change with each plan like:
Each Advantage Plan can charge different costs from your pocket. They can also have different rules for the ways you get services, like:
- If you desire to go to the doctors or healthcare providers belonging to the non-urgent and non-emergency care plan
- If you wish to see a specialist you must have a referral
These rules are subject to change every year.
Factors influencing costs of Advantage Plans of Medicare
The costs of Advantage Plans can vary on the basis of various factors. These factors may include
- Monthly premium of the plan,
- Monthly premium of Part B paid by the plan,
- Annual deductibles of the plan,
- Types of healthcare services required by you,
- Coinsurance or copayment made by you for each service
- Your compliance with the rules of the plan
- Annual limit of the plan for your out-of-pocket costs
- Medicaid got by you from the state