Medicare Advantage Plans
Medicare Advantage plans (also called Part C) are offered by private insurance companies and usually cover all services included in Parts A and B. They may even offer extra coverage like vision, hearing, dental, as well as health and wellness programs. Most plans also include prescription drug coverage (Part D).
- You must be enrolled in Parts A and B of Medicare to sign up for a Medicare Advantage plan.
- Different Medicare Advantage plans cover different services at different costs. You need to do your research to find a plan that fits your needs and budget.
- All Medicare Advantage plans limit the amount you will have to pay out-of-pocket each year. This allows you to budget more efficiently than Original Medicare, which has no limit on how much you may be responsible for.
- Medicare Advantage Part D – Plans that include prescription drug coverage allow you to get both your health care and prescription drug coverage from the same private insurance company in a single plan.
- Every insurance company that offers these plans has a contract with the federal government that is renewed annually.
Types of Medicare Advantage plans
There are a variety of Medicare Advantage plans available to meet individual needs, including, but not limited to the following coordinated care plans:
Health Maintenance Organization (HMO) Plan
- Must use doctors who belong to the plan.
- Must go to hospitals within the network.
- If you go outside the network, you have to pay for your own care (except for emergency, urgent services, and renal dialysis, which is covered nationwide).
- You will be required to choose a primary care physician.
- Primary care physician may manage care received from specialists.
- You may need a referral from your primary care physician to see a specialist.
Preferred Provider Organization (PPO) Plan
- More likely to have freedom to choose your doctor.
- Typically don’t need a referral to see a specialist.
- Can see doctors outside the network that participates with Original Medicare for a higher share of the cost.
Point of Service (POS) Plan
- Allows members to visit doctors and hospitals outside of the network – typically with a higher copay or coinsurance.
- Some plans do not require referrals for specialty services.
- May have a limit on out-of-network covered services
Special Needs Plan (SNP)
- Coordinated care plans designed for people with special needs.
- Combines hospital, doctor visits, outpatient care and prescription drugs in a single plan.
- Usually includes well-coordinated care, and may offer a manager or nurse practitioner, as an advocate for the member.
- Examples of people who may be eligible for SNP:
- People in nursing homes or long-term care facilities
- People eligible for Medicare and Medicaid (Dual Eligible Special Needs Plans)
- People with select chronic diseases
NOTE: There are other Medicare Advantage plan options available. For more information, visit www.medicare.gov.