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Medicare Advantage

Medicare Advantage is a type of Medicare health plan provided by a private company that contracts with Medicare in order to offer you all of your Part A and Part B benefits. If you are signed up to Medicare Advantage plan, the plan covers Medicare services and they are not paid for under original Medicare. In addition, the majority of Medicare Advantage plans also provide coverage for prescription drugs.

Types of Medicare Advantage Plans

The following type of healthcare plans are available to those who qualify:

  • Local Preferred Provider Organizations and Health Maintenance Organizations offer Medicare benefits. The HMOs make up most of total Medicare Advantage enrollments at 65%; local PPOs, make up 22% of all Medicare Advantage enrollees.
  • Regional PPOs make up 7% of enrollees and were created to offer rural recipients more access to Medicare Advantage plans, covering entire states or multiple state areas
  • Private Fee-for-Service plans, or PFFS, were approved in 1997, but not initially required to establish networks. However, they have commonly been required to do so since 2011. PFFS enrollment now makes up 3% of the entire enrollees in Medicare Advantage.
  • Special Needs Plans, or SNPs, usually HMOs, are limited to recipients that:
    • are both eligible for Medicaid and Medicare
    • reside in long-term care institutions and/or require institutional care
    • suffer from specific chronic conditions

How Does Medicare Advantage Work?

Medicare Advantage Plans are often referred to as “Part C” or “MA Plans”. Even if you choose to join a Medicare Advantage Plan, you will still have Medicare. You will have your Part A hospital insurance and Part B medical insurance through Medicare Advantage as opposed to original Medicare.

Medicare Advantage covers all Medicare services and may also provide additional coverage. Medicare pays a fixed amount each month for your care to the companies that provide the Medicare Advantage plans and adhere to the rules put in place by Medicare.

However, each plan may charge varying out-of-pocket costs and have different rules for services provided, such as requiring a referral to see a specialist or only allowing you to visit doctors or facilities that belong to the plan.

Prescription Drug Coverage

You will generally be able to obtain prescription drug coverage, which is Part D, through the Medicare Advantage plan. With some plans that do not provide prescription drug coverage, you may be able to join a Medicare Prescription Drug Plan.

However, you cannot have prescription drug coverage through both Medicare Advantage and a Medicare Prescription Drug Plan. If your Medicare Advantage plan includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you will no longer be enrolled in Medicare Advantage and thus returned to original Medicare.

How to Get Your Medicare Benefits

You have a number of options when it comes to getting your Medicare benefits depending on where you live. In most cases, you will be in the original Medicare plan when you first get your benefits. You may choose a Medicare prescription drug plan for additional coverage or a Medicare Advantage plan, such as a PPO or HMO that will give you all of your Part A, Part B, and usually Part D benefits.

This is a choice that you can make when you first become eligible for Medicare. Every year, you will need to review your health and prescription drug needs and may need to switch to a different plan in the fall. You should consider a few things that will help you meet your needs, such as:

  • Benefits – Are any additional services and benefits, such as hearing aids or eye exams covered?
  • Choices for doctors and hospital
    • Will you be able to go to the doctors that you prefer?
    • Are the doctors you choose accepting new Medicare patients?
    • Will you need to get a referral before going to a specialist?
    • Will you be able to go to the hospital you choose?
    • Does it cost you less to go to specific hospitals or doctors?
  • Choice of pharmacy – Which pharmacies will you be able to use?
  • Cost – What will your out-of-pocket expenses be, including the premiums?
  • Convenience – Where are the doctors in your plan located? What are their office hours? What paperwork is involved?
  • Prescription drugs – How much will you have to pay for prescription drugs under the Special Needs Plan? Is a list of covered drugs available? What are your specific prescription drug needs?
  • Travel – Do you spend time every year out of state? Will you be covered where you are at those times?

It is important to note that the quality of care provided varies among doctors, hospitals and plans. You deserve a health care provider that offers quality care by doing the right thing, at the right time and offering you the best possible results.

The freedom of choice is a great thing, but Medicare choices can be somewhat overwhelming. We are dedicated to keeping things as simple as possible and helping you make assured decisions when choosing your Medicare Advantage plan.

At Putnam Record Insurance Agency, we work to provide you with the best and most affordable policy for your unique needs. Submit the risk free quote form right now to get in touch with a member of our expert Medicare health insurance team and find out more about your options. Peace of mind and affordability are closer than you think.

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