What is a Medicare Advantage (Part C) Plan?
Medicare Advantage plans, sometimes called Medicare Part C, are health plan options that are part of Medicare. If you join one of these Medicare Advantage plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage usually includes prescription drug coverage–unless you choose one that does not (VA eligible, for instance).
Medicare Advantage plans include:
When you join a Medicare Advantage plan, you use the health insurance card that you get from the plan for your health care. In most of these Medicare Advantage plans, there generally are extra benefits and lower co-payments than in the Original Medicare plan. Most Medicare Advantage plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) where you see doctors that belong to the plan network or go to network hospitals to get services. In this way, they are similar to group health insurance plans.
To join a Medicare Advantage plan, (or a MediGap policy, for that matter), you must have Medicare Part A and Part B. You continue to pay your monthly Medicare Part B premium to Medicare. In addition, some plans have a monthly premium (in addition to your Medicare Part B premium) for the extra benefits that they offer. In 2023, the standard Part B premium amount is $164.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.
When Can I Enroll in a Medicare Advantage Plan?
Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare Health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage plans include the following:
Health Maintenance Organization (HMO) Plan. In most HMO plans, you go to doctors, other health care providers, or hospitals in the plan’s network of providers–except in an emergency. Usually, your primary care physician provides a referral when you need to see other doctors or specialists.
Preferred Provider Organization (PPO) Plan
A Medicare PPO plan is a type of Medicare Advantage plan (Part C) offered by a private insurance company. In a PPO plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) Plan
A Medicare PFFS plan is a type of Medicare Advantage plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare Supplement Insurance or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Medicare Special Needs (SNP) Plan
Medicare SNPs are a type of Medicare Advantage plan (like an HMO or PPO). Medicare SNPs are for people with specific diseases or health conditions, and often, income limits, and then tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage plans. Medicare does provide much more flexible enrollment/change opportunities for those enrolled in these SNP programs.
Source: The information above is obtained from www.medicare.gov
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