Medicare Advantage
What are Medicare Advantage Plans?
Medicare Advantage plans cover everything that Original Medicare covers. In addition, most Medicare Advantage plans include extra benefits and services that aren’t covered by Medicare, such as dental, vision, and hearing benefits. In addition, many include Part D prescription drug coverage. You must have Part A and Part B to purchase a Medicare Advantage policy.
Medicare Advantage Programs
HMOs
Health Maintenance Organizations have a defined network of providers. Typically your HMO will only cover services from an in-network provider except for emergency and urgent care. Often (but not always) your primary care physician will arrange your healthcare within the plan network; in other words, some plans require referrals.PPOs
Preferred Provider Organizations also have in-network providers, but you may also choose see providers who are not in your plan network. If you see out-of-network providers your cost sharing will usually be higher. In addition, many PPOs have national networks.SNPs
Special Needs Plans restrict membership to people who have Medicare and Medicaid, or have a chronic condition, or who are confined to a facility like a nursing home. These plans often offer additional benefits to help support the specific special needs of the SNP population.PFFSs
Private-Fee-For-Service plans may have a network but may offer more freedom to choose providers who are not in the plan network. Providers may choose to accept or to decline the plan’s terms and conditions at each visit. These plans are relatively uncommon. Provider Networks
Most Medicare Advantage plans have a list of providers who have a contract with the plan. These doctors, groups and facilities are “in-network” providers. A provider that isn’t contracted with the plan is considered “out-of-network.” If you see an out-of-network provider, you will typically pay more than if you see a contracted provider.
Prescription Drug Coverage
Most Medicare Advantage plans include Part D prescription drugs. If the plan does not include drugs, you can not purchase a separate Part D plan (except for Private-Fee-For-Service plans).
Extra Benefits
Medicare Advantage plans differentiate themselves from their competitors by offering extra benefits.
For example:
routine dental
vision benefits
special pricing for
hearing aides
debit cards to purchase healthy
foods at the grocery store
over-the-counter health and wellness allowance
personal emergency response devices
routine transportation
gym memberships
For example:
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