Medicare Advantage Plans
Medicare Advantage Plans (Part C) are healthcare plans offered by private companies that contract with Medicare to provide at least all your Part A and Part B benefits. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans.
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans (PFFS)
- Medicare Special Needs Plans (SNP)
When you join a Medicare Advantage (MA) Plan, you use the health insurance card that you get from the plan for your health care, and Medicare card. (In Florida, you only need your Medicare Advantage card.) Most MA plans…
- Offer extra benefits and lower co-payments than Original Medicare.
- Include Prescription Drug Coverage
- Are managed care plans: a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to use doctors and facilities that belong to the plan network
- All MA plans have a maximum out-of-pocket expense
Types of Medicare Advantage Plans
Medicare Advantage plans give you the same rights and protections as Original Medicare, plus additional benefits. Medicare Advantage Plans include the following:
Health Maintenance Organization (HMO) Plan
In most HMO Plans, you can only go to doctors, other healthcare providers, or hospitals in the plan’s network except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists.
Preferred Provider Organization (PPO) Plans
In a Medicare PPO Plan you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. The plans do not require a referral if you need to consult a specialist. You may pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) Plans
A Medicare PFFS Plan allows you to use any provider in the U.S. who accepts Medicare and agrees to accept the plan’s terms and conditions of payment. They do not require referrals. Some PFFS plans are networked and some are not. The plans may or may not choose to offer Part D benefits.
Medicare Special Needs (SNP) Plans
Medicare SNPs are Medicare Advantage coordinated care plans (HMO or PPO) designed to provide targeted care and limited enrollment to:
- Individuals who are institutionalized
- Dual eligibles (persons who qualify for Medicare and Medicaid)
- Those who who have a severe or disabling chronic condition, as specified by the Centers for Medicare & Medicaid Services (CMS), such as diabetes and heart failure.
These plans are often rich in benefits to help meet the members’ healthcare needs.
How do I join?
To join a Medicare Advantage Plan,
- You must have Medicare Parts A and B.
- You will continue to pay your monthly Medicare Part B premium to Medicare.
- You may pay a monthly premium for your Medicare Advantage Plan.