Medicare Advantage Plans
Medicare Part C
Medicare Advantage Plans do not discriminate concerning health conditions – with the exception of End-Stage Renal Failure – ESRD. There are special plans for ESRD.
Original Medicare is typically a 80/20% plan with a Part A deductible. Medicare Advantage Plans offer most services for a set Co-Pay, typically with no deductibles, assuring that you will always know what your out-of-pockets costs will be, rather than a unlimited percentage. Medicare Advantage Plans are a way to predict your healthcare costs throughout the year & all plans have a maximum out-of-pocket limit. Maximum Out-Of-Pocket is always stated in the Summary of Benefits, & will guarantee you that after that maximum has been paid by you, all other services for the year will be covered by $0 cost.
Original Medicare does not have a Maximum Out-Of-Pocket, placing your risk of liability much higher.
In many cases, your Medicare Advantage Plans (MA Plan) may offer extra coverage, such as vision, hearing , dental & health & wellness programs. Most will include Medicare Prescription Drug coverage. Some MA plans can be offered without Part D Prescription Coverage for those beneficiaries enrolled in other Part D plans through the VA or Employer Plans. You must be enrolled in Medicare Part A & Part B to participate in Part C. In some cases, your premium for Part C will be extremely inexpensive or perhaps $0 cost to you.
Medicare Advantage Plans, depending on the locations throughout the country, will offer HMO, PPO or Private Fee for Service Plans.
HMO Plans (Health Maintenance Organization):
Network based, with a Primary Care Physician appointed that will direct all your referrals for specialists. You cannot receive care outside the network & if you receive care outside the network, your cost will be 100% yours. *Emergency Care is provided Nationwide, same as in-network
Not all areas of the country will offer HMO coverage.
PPO (Preferred Provider Organization):
Generally, you have a broader selection of doctors, hospitals & other providers that belong to the network & you will pay less by using those providers. Generally, your Primary Care Physician will not need to direct you to specialists. You can go outside the network, but will pay a higher out-of-pocket cost.
Not all areas of the country will offer PPO coverage
PFFS (Private Fee for Service):
Similar to original Medicare, you can generally go to any doctor that will agree to treat you & accept Medicare terms & provisions. These types of plans are becoming more rare as time goes by, & are usually offered in more rural areas of the country where the population will not support HMO or PPO networks.
*ALL OR SOME OF THE ABOVE PLANS MAY BE OFFERED IN CERTAIN AREAS OF THE COUNTRY, DEPENDING ON YOUR ZIP CODE.
Medicare Advantage Plans have strict enrollment periods, unless you are Turning 65 or newly enrolled into Part B, then your enrollment period is 3 months previous to your 65th birthday (or Part B enrollment) the month of your birthday & the following 3 months of your 65th birthday (or Part B enrollment). A 7 month window of enrollment.
