Understanding Medicare Advantage Plans

Medicare Advantage, or Medicare Part C, offers a different way of receiving your Medicare benefits. Provided by private insurers with government subsidies, these plans often come at low or even no premiums, and create structured networks of healthcare providers.

Medicare Advantage plans typically include copays and a coinsurance system, which are the shared costs you'll take on when you use healthcare services. These plans stand out by offering additional benefits not included in Original Medicare, such as dental, vision, and hearing care, at no extra charge to you.

Benefits of Medicare Advantage:

• Convenience with a consolidated plan for all healthcare needs.

• Coverage encompasses all of Original Medicare's services, plus emergency and urgent care.

• Additional benefits like dental care, vision services, and wellness programs are common.

• Many plans roll in prescription drug coverage without extra fees.

• Open to all eligible individuals regardless of health or financial status.

• Attractively low premiums, often $0 in many markets.

• Deductibles are typically covered by the plan itself.

Considerations for Medicare Advantage:

• Provider networks are typically restricted, with non-emergency out-of-network care often not covered.

• Premiums may vary annually.

• Benefits can be subject to annual changes.

What Types of Plans are Available?

1. Health Maintenance Organization (HMO) Plans: These plans typically require you to seek care from providers within the plan’s network, except in emergencies or urgent care situations.

2. Preferred Provider Organization (PPO) Plans: PPOs offer a network of doctors where services are less expensive, but they also provide the flexibility to see out-of-network providers at a higher cost.

3. Private Fee-for-Service (PFFS) Plans: PFFS plans offer the flexibility to visit any healthcare provider that agrees to the plan’s payment terms. The plan sets the amount it will pay providers and the amount you will pay when receiving care.

4. Special Needs Plans (SNPs): SNPs cater to specific individuals with particular health needs, such as those eligible for both Medicare and Medicaid, residents of nursing homes, or individuals with chronic conditions.

Medicare Advantage (Part C) plans vary based on the plan type and location. To accurately assess the plans available in your area and the additional benefits they may offer, such as dental, vision, and hearing, please contact us!