What Is A Medicare Advantage Plan?
A Medicare Advantage Plan is an alternative to Original Medicare, offered by private insurers. Medicare Advantage plans are required to provide the same benefits as Part A and Part B of Original Medicare. Medicare Advantage plans are also commonly known to be like an “All-In-One” plan. Meaning than rather that have a separate plan for the Medical side and then another separate Medicare Plan for Prescription Drug coverage, many but not all, Medicare Advantage plans may include prescription drug coverage in the same Medicare Advantage plan, without additional premiums. Many Medicare Advantage plans also include dental, vision, and hearing benefits, which are Not included in Original Medicare or in a Medicare Supplement.
There are several types of Medicare Advantage plans. However, I am only going to cover two types (HMO & PPO) in this blog post.
Generally HMO Medicare Advantage plans are much more restrictive, but many times the least expensive. With most HMO plans, but not all, you are required to get a referral from your primary care physician to go to a specialist. Also you have to stay in network to be covered.
Medicare Advantage PPO plans are more flexible. PPO plans also have a network of providers, but unlike HMO plans, PPO plan allow you to go out of network, if you so desire. (Although it will cost you more to go out of your PPO network, instead of staying in-network.) In addition, PPO plans generally do not require you to get a referral from your primary care physician to see a specialist.
Many PPO’s and HMO’s have a lot of extra benefits that Original Medicare does not cover. Such as dental benefits, vision benefits, hearing benefits, memberships to fitness clubs may be included at no additional premium, OTC drugs allowances may be included, etc. Depending on your specific area, many PPO and HMO plans may have $0 premiums and $0 Medicare deductibles, as well a limit on Annual Maximum Out Of Pocket expenses!
Some important notes to be aware of:
- As with any Medicare Insurance plan, if it is a "true emergency" you can go to any provider and it will be considered in-network. But generally, for non-emergencies, you will want to go to an in-network provider or your out of pocket costs may be much higher (with a PPO Plan), or not even covered at all with an HMO. It will all depend on your specific plan.
- Be sure to check all your doctors and prescriptions BEFORE enrolling in a Medicare Advantage Plan. Make sure all your doctors are in-network OR that you are willing to switch to a new in-network doctor in the new plan. Also check that your drugs are covered at reasonable out of pocket costs to you, in the plan you chose.
- Medicare Advantage Plans and Prescription Drug plans generally can only be changed during Annual Election Period (AEP) unless you qualify for a Special Election Period (SEP) due to a qualifying event or reason.
- A Medicare Advantage Plan is NOT a Medicare Supplement.
(Medicare Supplements are totally different than Medicare Advantage plans!)
Medicare Advantage Plans are many times incorrectly confused with Medicare Supplement Insurance. (Medicare Supplements are also commonly known as “Medigap" plans). Both Medicare Advantage and Medicare Supplement plans are offered by private insurance companies. However Medicare Supplement plans cover people who only have Original Medicare Part A and Part B, (and possibly a stand alone prescription drug plan) and then that Medicare Supplement plan can fill gaps in Original Medicare by covering additional copays or coinsurance. Medicare Advantage Plans, by contrast, provide an alternative to Medicare Part A and Part B. You are not allowed to have both a Medicare Advantage Plan and a Medicare Supplement plan at the same time.
- Lastly, because Medicare Supplement plans are standardized, it is relatively easy to compare costs. Every Medicare Advantage Plan may be different, so comparison shopping can be difficult.
For the pros and cons of Medicare Advantage plans vs a Medicare Supplement, click on the web links below to other blog posts I wrote:
Medicare Advantage Plans - Pros and Cons
https://mgildarinsurance.com/blog/medicare/medicare-advantage-plans--.html
Medicare Supplements - Pros and Cons
https://mgildarinsurance.com/blog/medicare/medicare-supplements---pros.html
Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.
By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.
By calling this number, I understand I will be directed to a licensed insurance sales agent.