A Medicare Advantage Plan (Medicare Part C) is another medicare health plan option offered by private companies approved by Medicare.
Medicare Advantage plans are not supplemental insurance, but rather health insurance plans of their own. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental.
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 Organization (HMO) Plans: An HMO plan requires members to select a primary physician who then acts as a mediator to other medical services. Primary Care Physicians (PCP) are typically general practitioners, family doctors or pediatricians. In order to visit a specialist, a referral from a PCP is required. These specialists must operate in your network, otherwise costs are not guaranteed to be covered. HMOs often provide preventative, general care at a much lower cost-and sometimes even free. Experimental treatments or out-patient services are less likely to be covered under an HMO, as the primary focus of this plan references its’ namesake- maintenance and preventative care.
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.
Private Fee-for-Service (PFFS) Plans: With these plans, Medicare pays a set amount of money to the insurance company every month and then the insurance company determines your cost for services. Because these plans are contingent upon where an insurance company wants to do business, there may only be PFFS plans in some parts of the country.
Special Needs Plans (SNP): Medicare Special Needs Plans are for individuals with certain chronic diseases or conditions and therefore have special needs. These plans were designed to give people with special needs better access to Medicare for specialized care.
Medical Savings Account (MSA) Plans 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.
Interesting Stats On Medicare Advantage Coverage:
Enrollment for Medicare Advantage (Part C) grew from 5.4 million in 2005 to 8.2 million in 2007
As of 2008, 19% of patients receiving Medicare coverage received it in the form of a Medicare Advantage Plan
1/3 of Medicare recipients receiving Part D coverage are enrolled in a Medicare Advantage Plan
It is interesting to note that almost half (48%) of the people receiving Medicare Advantage coverage have an 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.
Learn more about Medicare and Medicare Advantage Plans. Stop by Jason Milz’s site where you can find out all about Wisconsin Medicare Insurance.