Understanding Medicare Advantage
Medicare Advantage plans are an all-in-one alternative to Original Medicare. Rather than purchasing additional Medicare benefits separately, as you would need to do with Original Medicare, Advantage plans allow you to bundle all of your health insurance needs into a single plan.
Medicare Advantage Coverage
Medicare Advantage plans are provided by carriers who have contracted with Social Security to provide you with your Part A and Part B benefits. In many cases, they can also provide you with Part D prescription drug coverage. Beyond the basic benefits, Medicare Advantage plans may also offer you access to additional benefits that are not available through Original Medicare. Some highly sought benefits that Advantage plans offer include hearing, dental, and vision coverage. These benefits cannot be found through Original Medicare.
Unique Medicare Benefits
Medicare Advantage plans offer a diverse range of supplemental benefits. For example, some plans include coverage for services like transportation to doctor visits and preventive services. Others will help you pay for necessities, such as meal delivery. If you enroll in a plan that is tailored to individuals with specific health conditions, your benefits can even include coverage for services that are specific to your individual needs.
Types Of Medicare Advantage Plans
There are several different types of Medicare Advantage plans currently available on the market. Each one offers different benefits, and allows you to see a different range of providers for health care services. In some cases, your Medicare Advantage plan will only allow you to seek care from health care providers who are within a specific network. Other plans will allow you to access out-of-network providers at a potentially higher cost. The type of Advantage plan you choose will determine who you can see and how much it costs. Here are the four most common types of Medicare Advantage plans.
- Health Maintenance Organization (HMO) – HMO plans are restrictive plans that only allow you to receive care from providers that are within the network of your plan. Though, you may be able to receive emergency or out-of-area urgent care under these plans as well. Most HMO plans offer prescription drug coverage as well, meaning you won’t need to look outside of your plan for this valuable benefit. You may need a referral to see a specialist with an HMO.
- Preferred Provider Organization (PPO) – PPO plans are more flexible than HMO plans because they allow you to receive care from providers that are in their network and outside the network. Though, you may have to pay more to see providers that are outside of the network. Prescription drugs are often covered in most of these plans. You also won’t need to get a referral to see specialists in most cases.
- Private-Fee-For-Service Plans (PFFS) – PFFS plans are Advantage plans that allow you to receive care from any doctor or health care provider in most cases. Some PFFS plans may have a network, but you can choose to receive care from out of network providers as well. With these plans, the plan has set rates that they are willing to pay for services. If your provider agrees to those terms, you can see them. With PFFS plans, you won’t need a referral to see specialists.
- Special Needs Plans (SNP) – SNPs limit membership to individuals with specific diseases, disabilities, or characteristics. In most cases, you’ll need a referral to see a specialist, and you generally must seek care from providers that are within your network. Most SNPs also include prescription drug coverage.