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A Medicare Advantage plan is an alternative way to get Medicare coverage through private insurance companies instead of the federal government.
A Medicare Advantage plan will have all the benefits of Medicare but may also include extra coverage such as vision, hearing, dental and health and wellness programs. Most programs also include Medicare prescription drug coverage. A Medicare Advantage plan is a good plan if you are looking for an all-in-one medical and drug coverage plan.
There are three general eligibility requirements:
- You must be enrolled in Original Medicare (Part A and Part B)
- There must be a Medicare Advantage plan offered in your area
- You do not have End Stage Renal Disease (ESRD)
You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.
There are different types of Medicare Advantage plans:
- Health Maintenance Organizations (HMOs) – offers low cost coverage with physician and hospital network restrictions. Most HMO require that you pick a primary physician and you will need a referral to see a specialist. If you see a provider out of network, your insurer may not pay for it.
- Preferred Provider Organizations (PPOs) – also offers coverage through a network of providers, but you are allowed to access out-of-network care for a higher cost. You don’t need elect a primary physician and usually don’t need a referral to see a specialist.
- Private Fee-for-Service (PFFS) – you may go to any Medicare-approved doctor or health care facility that has accepted the plan’s payment terms and has agreed to treat members of the plan. You do not need to choose a primary physician and you do not need a referral to see a specialist.
The type of plan you choose may affect your prescription drug coverage options, referral requirements, and network restrictions.
If you enroll in a Medicare Advantage plan, you may have to pay some or all of the original Medicare premiums, Medicare Advantage plan premiums and out-of-pocket costs such as co-pays, co-insurance and deductibles.
You may often see where Medicare Advantage plans are advertised as Zero cost. Although there is a premium, often the average monthly premiums is lower than what you would pay for Medicare Part B. You are still paying a premium, but it likely will be less than if you elected Medicare and you are getting additional benefits – so essentially there is Zero cost.
We understand that making your elections for health benefits can be confusing and sometimes a little scary. We can help – we are Medicare Certified and can help you navigate through your different options and choose the right plan for you.