What is Medicare Advantage?
The Medicare Advantage plan, also known as Medicare Part C, is available to anyone who's over the age of 65, and currently covered by Medicare Parts A and B. Any service that's covered under Part A and B is also covered under the Advantage Plan. An additional premium payment is required in addition to the premium you pay for Plan B. Copays and deductibles vary depending on which Advantage Plan you purchase. There are four plan options to choose from. Which option is right for you will depend on cost, and whether or not you have a preference when choosing doctors and facilities.- In addition to covering copays and deductibles not covered under Medicare Parts A and B, Medicare Advantage Plans will pick up some of your prescriptions costs, as well as vision and dental expenses. The drawback with Advantage Plans is participants can only see doctors who are part of a specific network in order to reap the full cost benefits from the plan. Also, any appointments with a specialist must be referred by a doctor from within the network. Seeing a doctor, or specialist who's not part of the network means the plan won't cover as much, or it may not cover the service at all.
Medicare Advantage Plans are offered through independent insurance companies, unlike the government-sponsored traditional Medicare plans. There are no standardized pricing models, so different insurance companies will offer different prices for the same plan. Whether or not Medicare Part C is available in your area will depend on population needs. Because these are independent companies they do reserve the right to cancel a plan within a particular area if there aren't enough people under it. The disadvantage here is participants will have to find alternative coverage on their own.- Regardless of which type of Advantage Plan you choose, all of them work in conjunction with managed care networks. The four plan options available are Point-of-Service (POS), Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO) and Provider-Sponsored Organizations (PSO). Provider-Sponsored Organizations are facilities which handle all aspects of the insurance coverage process. There is no third party insurance company to deal with. This is a closed network, so only doctors who work in the facility are covered under this option. Health Maintenance Organizations are the least expensive of the four. Doctors and specialists must be a part of the network to be covered by the plan.
Point-of-Service plans allow participants more freedom in choosing their doctors and facilities; however plan coverages are less for doctors and facilities who work outside of the network. Preferred-Provider Organizations provide the exact same benefits and requirements as Point-of-Service Organizations. The only difference is PPO's are located in urban areas. POS's are mostly in rural areas.
As Medicare Advantage plans are designed to pick up where traditional coverage leaves, anyone who already has a Medigap plan in place won't need this plan since both pretty much cover the same expenses. Plan coverages that include vision, dental and prescription benefits will be more costly. And since prices vary from company to company, it's always best to shop around before making a decision. Something else to look into is your locale's population needs where Medicare coverage is concerned. This is to avoid an unexpected policy cancellation. Where you're located, as well as your own individual healthcare needs will best determine which Advantage Plan option is right for you.
