Medicare Advantage Plans
Medicare Advantage
What is Medicare Advantage?
A Medicare Advantage (MA) plan is a health plan that provides Medicare Part A and Part B coverage through a private company that has been approved by Medicare. MA plans are also known as Part C plans. They can be an alternative to Original Medicare and may offer lower out-of-pocket costs, extra benefits, and different rules for accessing services. However, MA plans may also have restrictions, such as requiring prior authorization for certain procedures or referrals to see specialists.
Here are some things to consider about MA plans:
Benefits
MA plans may include benefits that Original Medicare doesn’t cover, such as vision, hearing, and dental services. They may also offer extra coverage to help lower prescription drug costs.
Costs
Most MA plans have low monthly premiums, and some may not charge any at all. However, you’ll also pay other costs when you get prescriptions, such as a deductible or a late enrollment penalty.
Restrictions
MA plans may require you to use doctors who are in their network, and you may need to get a referral from your primary care physician to see a specialist. You may also need to get approval from your plan for certain tests or procedures, which could delay care.
Stability
There’s a chance that your MA plan could end coverage, either by the insurer or the network. If this happens, you’ll be notified and offered other options.
Before joining an MA plan, you should review your coverage options and talk to your employer, union, or other benefits administrator. You can also compare your Medicare options.
Compare Medicare Advantage Plans
| Plan Type | HMO Health Maintenance Organization | PPO Preferred Provider Organization | PFFS Private Fee-for-Service Plan | SNP Special Needs Plan | MSA Medicare Savings Account |
|---|---|---|---|---|---|
| Premium Do most plans charge a monthly premium? | Yes Many charge a premium in addition to the monthly Part B premium. | Yes Many charge a premium in addition to the monthly Part B premium. | Yes Many charge a premium in addition to the monthly Part B premium. | Yes Many charge a premium in addition to the monthly Part B premium. | No You won’t have to pay a separate monthly premium, but you’ll continue to pay your Part B premium. |
| Drugs Does the plan offer Medicare prescription drug coverage (Part D)? | Usually If you join an HMO plan that doesn’t offer drug coverage, you can’t get a separate Medicare drug plan. | Usually If you join a PPO plan that doesn’t offer drug coverage, you can’t get a separate Medicare drug plan. | Usually If your PFFS Plan doesn’t offer drug coverage, you can get a separate Medicare drug plan. | Yes All SNPs must provide Medicare drug coverage (Part D). | No You may join a separate Medicare drug plan. |
| Providers Can I use any doctor or hospital that accepts Medicare for covered services? | Sometimes You generally must get your care and services from doctors, other providers, or hospitals in the plan’s network (except emergency or urgent care or out-of-area dialysis). In an HMO Point-of-Service (HMOPOS) Plan you may be able to get some services out of network for a higher copayment or coinsurance. | Yes Each plan has a network of doctors, hospitals, and other providers that you may go to. You may also go out of the plan’s network, but your costs may be higher. | Yes You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you. If the plan has a network, you can use any of the network providers. (If you go to an out-of-network provider that accepts the plan’s terms, you may pay more.) | Sometimes If your SNP is an HMO, you must get your care and services from doctors or hospitals in the SNP’s network (except for emergency, urgent care, or out-of-area dialysis). However, if your SNP is a PPO, you can get Medicare-covered services out of network. | Yes MSA plans generally don’t have network providers. You may go to any Medicare-approved provider for services that Original Medicare covers. |
| Primary Care Do I need to choose a primary care doctor? | Usually | No | No | Varies by plan Some SNPs require you to choose a primary care doctor and others don’t. | No |
| Referrals Do I need a referral from my doctor to use a specialist? | Yes | No | No | Maybe If the SNPs is an HMO, you need a referral. If the SNP is a PPO, you don’t need a referral. | No |
