Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage Plans are another Medicare health plan choice that can be selected as part of Medicare. These plans tend to have more coverage than just regular Medicare and are distributed by Medicare approved Private Insurance Companies.
*Medicare pays a set amount of money every month to the private insurance companies to offer these plans
*These plans are run by Private Insurance Companies while Medicare (Parts A, B, D & Gap) is run by the Federal Government.

What they offer;
These plans are required to provide all of Part A (Hospital Insurance) and Part B (Medical Insurance) and they may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. They are not required to cover hospice care.
Most also include Medicare prescription drug coverage (Part D), but the extra coverage is determined by the provider and the depth of the plan itself.

Note that the insured are always covered for Part A and the plans must cover all of the original services of Medicare.

How they work
Medicare pays a fixed amount every month to the companies offering Medicare Advantage Plans in the form of subsidies. The companies that receive these subsidies must follow rules set by Medicare, but each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non emergency or non-urgent care). Please note that these rules can change each year.

Premiums, Deductible and Co Pays
All plan members pay same premium regardless of age, gender, or health. Cost sharing (co pays) must be paid for most medical services. Many plans have an out-of pocket annual maximum. The difference in premiums is created by the different types of coverage needed by the beneficiary.

*The premium for Advantage Plans is usually higher than the monthly premium for Medicare Part B.

Types of Plans

HMOs – maintains a provider network and referrals may be necessary
PPOs – also has a provider network but allows beneficiaries to obtain care outside the network if they pay higher amounts.
PFFS – no network which can lead to issues finding providers that will accept it
SNPs – membership is limited to certain groups of people, such as those in certain institutions (like a nursing home), those eligible for both Medicare and Medicaid, or those with certain chronic or disabling conditions.
HMOPOS -an HMO plan that may let you get some services out of network for a higher cost.
MSA – Medical Savings Accounts

Prescription Drug Coverage
If choosing a PPO or an HMO the beneficiary must enroll in the provided Rx plan
If choosing a PFFS plan the beneficiary can choose either the plan’s Rx coverage, if offered, or a stand-alone PDP.

Other
These plans are not standardized; any qualified Private Insurance Company can build what they believe the markets wants but they are all regulated by Medicare.

*It is illegal for someone to sell a beneficiary a MediGap Policy if there is already an Advantage Plan in affect

An Example (We are not endorsing any one company)
Random Insurance Companies PPO;

• Freedom to choose any doctor or hospital, but you pay less for services received from in-network providers, even when traveling
• Affordable monthly plan premium for most plans
• Referral-free visits to any provider nationwide
• Prescription drug coverage equal to or better than the standard requirement for a Medicare Part D plan – Drug coverage not available for all plans
• Emergency coverage anywhere in the world
• Affordable copayments for doctor visits and annual routine physicals
• Coverage for annual screenings at no charge
• Out-of-pockets costs are lower when you choose a provider from list of in-network providers
• All the benefits of Original Medicare and more, including:
o Prescription drug coverage (some plans do not include drug coverage)
o Emergency coverage when you travel outside the United States

*Dental, Vision, Hearing, Wellness/Fitness Benefits and Podiatry are add-ons to basic coverage which will increase the out of pocket premiums and not all Providers have them.

The Cons to an Advantage Plan
From a report created by the Medicare Rights Center;
The report, based on thousands of beneficiary calls to the Medicare Rights Center, lists nine common problems with Medicare Advantage plans. The problems include the following:
• Care can cost more than it would under original Medicare.
• Private plans are not stable and may suddenly cease coverage.
• Members may experience difficulty getting emergency or urgent care.
• Because plans only cover certain doctors, the continuity of care is often broken when the plan drops a provider.
• Members have to follow plan rules to get covered care.
• Members are restricted in their choices of doctors, hospitals, and other providers.
• It can be difficult to get care away from home.
• The extra benefits offered often turn out to be less than promised.
Here is a link to the original page, which has moved and for some reason Medicare Rights Center no longer has any data on the report.
http://www.elderlawanswers.com/resources/article.asp?id=6247