Medicare Advantage

Medicare Advantage

Medicare Advantage, also called MA or Medicare Part C, is an alternative to Original Medicare offered by private Medicare-approved companies. Depending on your medical care needs, Medicare Advantage may offer you more appropriate coverage and potentially save you money. 

Medicare Advantage provides full Original Medicare coverage (Parts A and Part B), and may include extra coverage such as vision, dental, and/or wellness and fitness programs like gym memberships. These plans offer a bundled alternative to Original Medicare and usually include Medicare Part D (prescription drug coverage) as well. You can often customize your benefits packages for your specific health care needs. 

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How Does Medicare Advantage Work?

Each month, Medicare pays a fixed amount for your medical care to the private companies that offer Medicare Advantage. These companies are required to follow Medicare’s rules. But unlike Original Medicare, each Medicare Advantage plan can charge different out-of-pocket costs and may have different rules about how you access care. These rules are subject to change and may change as often as each year.

The Different Kinds of Medicare Advantage Plans

These are the two most common types of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO) Plans, where you typically need to get your care from providers within the plan’s network (exceptions include emergency care, out-of-area urgent care, and out-of-area dialysis) 
  • Preferred Provider Organization (PPO) Plans, where you pay less when you use in-network doctors, health care providers, and hospitals

These Medicare Advantage Plans are also available, and are less common than HMO or PPO plans: 

  • Private Fee-for-Service (PFFS) Plans, which determines how much it will pay health care providers and hospitals, and how much you have to pay to get services 
  • Special Needs Plans (SNPs), which are limited to to people with specific diseases or characteristics and tailor benefits for those groups of people
  • Medicare Medical Savings Account (MSA) Plans, which consists of a high deductible and savings account to cover your medical costs.

Is Medicare Advantage a Fit For You?

Of course, everyone’s healthcare needs are unique and different. Following are some of the key benefits of choosing Medicare Advantage:

  • Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, and often they provide more coverage. That coverage could include dental care, vision care, hearing aids, prescription drugs and more. 
  • You may pay less with Medicare Advantage. The premium for Medicare Advantage plans is decided by the private insurer, which will vary from one plan to another. Some Medicare Advantage plans can have premiums as low as $0, and your cost sharing may also be less under Medicare Advantage than original Medicare.
  • Unlike Original Medicare, Medicare Advantage limits your maximum out-of-pocket expenses. Once you have spent the maximum amount, you pay nothing for covered services for the rest of the year. 
  • Medicare Advantage typically includes Part D, prescription drug coverage, while Original Medicare does not. 

However, it’s important to note that Medicare Advantage plans generally have more restricted provider networks, have regional (rather than national) networks of providers, and often require your doctor’s referral before they will pay for services. 

Not Sure If Medicare Advantage Is Right For You?

We get it! That’s why we’re here to help. With years of experience, you can trust us to help you get the right coverage for you. Give us a call at (866) 445-5215 or email us at info@seniorhealthsol.com.

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