Medicare Advantage Plans

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  • Also called Medicare Part C.
  • Like an HMO or PPO.
  • Covers all Part A and Part B services.
  • Extra coverage like vision, hearing, dental, gym membership, and other health and wellness programs.
  • Usually includes prescription drug coverage (Medicare Part D).
  • $0 monthly premiums available.

What Are The Different Types of Medicare Advantage Plans?

 

  • Health Maintenance Organization (HMO) plans - In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan's network except in an urgent or emergency situation. You may also need to get a referral from your primary care physician  for tests or to see other doctors or specialists.
  • Preferred Provider Organization (PPO) plans - In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong in the plan's network. You can also use out-of-network providers for covered services but usually at a higher cost. Most plans don't require referrals to see a specialist and you don't need to choose a primary care physician.
  • Private Fee-for-Service (PFFS) plan - PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan's payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
  • Special Needs Plan (SNP) - SNPs provide focused and specialized health care for specific groups like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions like diabetes, cardiovascular disease and congestive heart failure.
  • Medical Savings Account (MSA) - Similar to Health Savings Accounts outside of Medicare. Combines a high deductible insurance plan with a medical savings account that you can use to pay for your health care costs. You can choose your healthcare services and providers. 

What Else Should I Know About Medicare Advantage Plans?

 

  • You have Medicare rights and protections, including the right to appeal.
  • You can check with the plan before you get a service to find out if it's covered and what your costs may be.
  • You must follow plan rules. It's important to check with the plan for information about your rights and responsibilities.
  • If you go to a doctor, other health care provider, facility, or supplier that doesn't belong to the plan's network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.
  • Providers can join or leave a plan's provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
  • If you join a clinical research study, some costs may be covered by Original Medicare and some may be covered by your Medicare Advantage plan.
  • Medicare Advantage plans can't charge more than Original Medicare for certain services, like chemotherapy, dialysis, and skilled nursing facility care.
  • Medicare Advantage plans have  a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you'll pay nothing for covered services. This limit may be different between plans and can change each year.


 

Medicare Advantage plans take over for original Medicare and provide a menu of copays and deductibles to help you reduce your health care costs. Many plans have a $0 monthly premium and could be the perfect choice for someone looking to minimize their health care costs. Each plan has a maximum annual out of pocket cost to help you avoid financial hardship should the worst case scenario occur.  There are several options and operational models available for Medicare Advantage plans depending on what county a beneficiary may reside in such as HMO, PPO, PFFS, MSA and SNP. Senior HealthPlan Services can help you to determine which Medicare Advantage plan best suits your needs. We can show you plans from companies such as United Healthcare, Blue Cross Blue Shield, Caremore, Allcare, Health Choice, WellCare, Aetna, and Humana.  Contact us today to schedule a free consultation.


Has your Medicare Advantage plan recently dropped a provider from their network or has the plan been terminated in your area? Are you turning 65 and curious about how Medicare Advantage plans work and which ones are available in your county? Senior HealthPlan Services can help you to determine which carrier has the best plan for you.  We are appointed with all the top carriers in the region to provide you with unbiased and professional advice to help you decide which plan is best for you. We take a consultative and educational approach to presenting Medicare plans and believe that you have the right to understand all the available options so you can make a fully informed decision.


We are always available to answer any questions you have about your current Medicare Advantage plan and conduct an annual review with each client to ensure that they are recieving the best service and care possible. Plans can change from year to year and we feel its important to keep our clients informed about any changes or new plans that become available in the area where you reside.  Senior HealthPlan Services stays well informed about what is happening in the senior health marketplace and is dedicated to educating the public about any news and events that could affect our senior population's well-being. 

Check out our blog to see current articles about changes in healthcare legislation, company news, rate changes, and tips on how to maximize your savings in the Medicare system.