Medicare Advantage Plans, also known as Medicare Part C plans, are health insurance places that are approved by Medicare and run by private insurance agencies. Medicare Advantage plans are required to provide all the same benefits as Medicare Part A and Part B and may include prescription drug coverage. These plans add additional coverage, including vision, dental, medical transportation, health club memberships, and hearing aid coverage. There are many different types of Medicare Advantage plans. We can help you select the best plan for your needs.
PREFERRED PROVIDER ORGANIZATIONS (PPO)
PPOs allow you to receive healthcare from any doctor or healthcare provider in the PPO’s network. You can also go to other providers that aren’t in your network, but it generally costs more. You are able to see a specialist without a referral.
Health Maintenance Organizations (HMO)
HMOs require you to receive care for doctors and other providers in your plan’s network, excluding emergency care. You select an in-network provider, and they coordinate your care and give you a referral to another in-network specialist if needed. In some plans, you may be able to see out-of-network providers for certain services, but the cost is much higher.
Private Fee-for-Service (PFFS)
With a PFFS plan that has a network, you can see any of the in-network providers who agree to treat you. You can also choose from out-of-network providers that accept the plan’s terms, but it may cost more. If your PFFS plan doesn’t have a network, you can go to a Medicare-approved provider or other provider who accepts the plans payment terms and agrees to treat you. In case of an emergency, doctors and hospitals are required to treat you.
Medicare Special Needs Plan (SNP)
SNP plans generally require you to get care from providers and hospitals in the SNP’s network. They typically have specialists that treat conditions that affect their members. In case of an emergency, doctors and hospitals are required to treat you.
- You must have Medicare Part A and Part B to enroll in a Medicare Advantage plan.
- You still have Medicare if you enroll in a Medicare Advantage plan, and you must still pay your monthly Part A and Part B premium, if you have one. Each Medicare Advantage plan must provide all Part A and Part B services, but it can do so with different rules, costs, and restrictions than original Medicare plans.
- Medicare Advantage plans generally charge a premium in addition to the Part B premium. Most also charge a copayment that you are required to pay at the time of service. Some plans also charge a coinsurance for some or all services.
- All Medicare Advantage plans must include a limit on your out-of-pocket expenses for Part A and Part B Services, which can be costly. These plans can’t include copays or coinsurances that are higher than they would be normally under original Medicare for certain services, but other services may be higher.
- Medicare Advantage plans can provide additional benefits including hearing aids, vision, dental, and medical transportation.
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If you have any questions regarding insurance options for yourself, your loved ones, or your employees give us a call today, or contact us to receive a free insurance quote!
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.