Medicare Advantage

Medicare Advantage plans are an alternative to Original Medicare that can offer you additional coverage within a network of regional healthcare providers.

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Medicare Advantage

Medicare Advantage plans give you the coverage of Medicare Part A and Part B: inpatient, medically necessary and preventative care services. They can also offer additional packages with benefits including dental, vision, and hearing care, which are not covered under Original Medicare.

Medicare Advantage Prescription Drug plans offer a crucial benefit that you won’t find under Original Medicare. This type of Medicare Advantage plan has coverage equivalent to Medicare Part D plans. Each plan will vary in its costs and the prescription drugs it covers, but you can easily compare these options. All plans have a formulary, or list of covered drugs, that you can refer to when looking for a plan that meets your needs. 

Medicare Advantage Costs

When you sign up for a Medicare Advantage plan, you still need to pay your Part A and Part B premiums, although some plans offer rebates to help you pay these costs. Under your Medicare Advantage plan, you will pay premiums for the plan and any additional benefits that you purchased.

At each medical visit, you will present your Medicare Advantage plan’s insurance card. Your health care provider will be charging the plan instead of Medicare itself. You will be charged copayments and coinsurance as a form of cost sharing with your insurance company.

Part A care has a daily coinsurance after you have spent 60 days in the hospital or 20 days in a skilled nursing facility. Part B copayments mean you are responsible for up to 20% of the Medicare-approved amount for a covered service, item or test.

Medicare Advantage Prescription Drug plans will charge you an additional premium which may be built into the plan’s basic premium. Until you meet the prescription deductible, you will pay the full cost of your prescriptions. Once you meet the deductible, you will pay only small copayments for each prescription drug. 

The copayment amount you pay depends on the tier list your plan has developed. This tier list sorts drugs for whether they are generic, brand-name, or specialty and whether or not they are preferred. Generic, preferred drugs have the lowest copayments and specialty prescriptions have the highest.

Medicare Advantage Plan Types

There are a few main types of Medicare Advantage plans: HMO, PPO, PFFS, and SNP. Most plans contract with networks of healthcare providers in your region to bring you lower negotiated rates for covered services.

Health Maintenance Organization (HMO) plans require you to have a primary care provider and to get a referral before you can see a specialist. These plans do not cover you for services you receive from out-of-network providers.

Preferred Provider Organization (PPO) plans are more flexible in comparison to HMOs. They do not require you to have a primary care provider, do not require referrals in most cases, and will cover you for services outside of the network, but you will pay more for those services.

Private Fee-for-Service (PFFS) plans allow you to seek healthcare services from any provider that agrees to the terms of your plan and accepts the plan as payment. Some PFFS plans will have networks of providers.

Special Needs Plans (SNP) plans are designed for specific conditions or groups of people. There are plans for people with chronic conditions, dual eligibility with Medicare, and people who are institutionalized.

To learn more about your Medicare Advantage options, reach out to the Medicare experts at Better Insurance Management.