Medicare Advantage Plans
- Offered by private insurance companies, Medicare Advantage plans replace Original
Medicare coverage. They often provide broader coverage but limit the range of doctors
and providers your loved one can use.
- A Medicare Advantage plan may cover prescription drugs, so your loved one may not
need Prescription Drug Plans (Part D).
- Claims must be submitted to and paid by the health insurance company--not the federal
government.
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Investigate the different plans available by using Medicare’s plan comparison tool.
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Medicare Advantage plans, offered by private health insurance companies, replace
Original Medicare coverage. These plans combine all the core Medicare benefits with
certain additional benefits into one combined plan. In many cases, prescription
medications are also covered, making it unnecessary to purchase Prescription Drug
Plans (Part D).
To be eligible for a Medicare Advantage plan, your loved one must live within its
service area and be covered by Original Medicare (if your loved one moves, he or
she will likely need to change plans). By law, Medicare Advantage plans must cover
at least the same fees and services as Original Medicare. In fact, a person with
Medicare Advantage coverage remains enrolled in Medicare and retains the same rights
and protections.
Are there different types of Medicare Advantage plans?
Several types of plans are available, each with different benefits, provider choices,
and cost-sharing rules. Your loved one will still need to pay the Part B premium
and may have to pay an additional premium. Medicare Advantage plans include:
Medicare Managed Care Plans
These include plans such as health maintenance organizations (HMOs), Preferred Provider
Organizations (PPOs), and Point of Service (POS) plans sold by private health insurance
companies. Generally, they require your loved one to use the plan’s pre-approved
facilities and providers within specific locations.
Medicare Private Fee-For-Service Plans
These plans offer a wider range of provider choice than Managed Care plans. The
health insurance company pays a specified share of the medical expense; your loved
one pays the remainder.
Medicare Medical Savings Account Plans
These plans have two components. The first is a Medicare Advantage health plan with
a high deductible. The second is a Medical Savings Account into which Medicare deposits
money your loved one can use to pay costs until the deductible is reached. If you
don’t spend the money in the account, it rolls over to the next year.
Medicare Special Needs Plans
Available in some parts of the country, Special Needs Plans (SNPs) are designed
to help manage and coordinate all the services needed by people who have certain
chronic diseases and conditions. They provide all the elements of Original Medicare
and Prescription Drug Plans (Part D) with additional benefits and possibly lower
copays.
Next Step: Investigate the different plans available by using Medicare’s plan comparison tool. Use Medicare’s tool
