Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... are organized and sold county-by-county. The reason for this, versus national plans, is that most private health insurance use provider networks, which are local. In this MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer.... article, we’ll help you find plans in your area and give you tips to help you choose the best plan.
Key Takeaways
- Medicare Advantage plans are organized locally.
- Medicare Advantage plans are private health insurance policies that replace Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.... benefits and may include additional benefits not offered by Medicare Part AMedicare Part A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... or Medicare Part BMedicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care.....
- Medicare Advantage plans are not compatible with Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage.... (you can’t have both).
- If you have both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.... benefits, you may qualify for a Medicare Advantage Special Needs Plan (SNP).
There is no simple answer to a question, like, “Who Has the Best Medicare Advantage Plan?”, or “What are the top 3 Medicare Advantage plans?”, which will be different depending on where you live.
For this reason, we’ve done our best to organize and catalog Advantage plans to show you the best plans visually using the Centers for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs.... star ratings. All you have to do is enter your zip code in the box below to get started. We do our best to make comparing Medicare Advantage plans easy.
How Are Medicare Advantage Plans Different From Original Medicare?
Original Medicare is a private fee-for-service system. Approved healthcare providers (e.g., doctors, hospitals, nursing homes, etc.) agree to accept a set payment for their services. Medicare pays about 80 percent of Medicare-approved costs. The beneficiaryA person who has health care insurance through the Medicare or Medicaid programs.... pays the remaining 20 percent for their Medicare coverage.
Although all Medicare Advantage plans agree to provide the same Medicare-approved services included in Medicare Part A and Part B, they are not required to cover them in the same way. Specifically, a plan can charge you both a monthly premium to be in the plan and copayments when you use health services. Also, a plan can mandate that you get a referral to use various healthcare services (i.e., specialists, lab tests, diagnostics, etc.). Referrals are not required for wellness visits or when you need to see your primary care physician. You also do not need a referral for a hospital stay due to an emergency or to go to urgent care.
Aside from the cost and control differences cited above, another big difference is the extra benefits insurance companies can add to their plans. One of the top benefits plans add is prescription drug coverage (Medicare Part D plan). Other popular benefits include routine dental, vision, and hearing. Some plans even offer SilverSneakers as one of their additional benefits so their members can stay fit.
On the plus column for Original Medicare, you don’t have to deal with open enrollment when you have Part A and Part B coverage, and there are no network providers or service area restrictions within the USA.
Do I Still Need Medigap Insurance?
Medicare Advantage is an alternative to Original Medicare and a Medicare supplement (Medigap). The two types of insurance are not compatible. If you enroll in a Medicare Advantage plan, you will automatically be disenrolled from Medicare Part A and Medicare Part B. At the same time, if you have a supplement, the insurance carrier will be notified and will cancel your policy.
What is Medicare Part C?
Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all... is another name for Medicare Advantage. There’s no difference between Part C plans and Medicare Advantage plans. The federal Medicare programMedicare is a federal health insurance program for people ages 65 and older and people with certain disabilities.... organizes benefits in lettered parts, A, B, C, and D. Parts A and B are Original Medicare. And Part D is for Medicare prescription drug plansMedicare Part D is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.....
What Are Medicare Advantage PPO Plans?
Preferred Provider Organization (PPO) plans are one of the most common types of Advantage plans. The other common plan type is a Health Maintenance Organization (HMO) plan. Most people choose one of these two types of Medicare Advantage Plans.
Both Medicare Advantage HMOs and PPOs use network providers. The difference is that with an HMO you must use the plan’s network. However, with a PPO you have the option to use a provider that’s not in the network, but you’ll pay more in out-of-pocket costs (e.g., copayments or coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. ...). With HMO plans, you must use the provider network.
Another type of plan that’s gaining popularity are PFFS plans (private fee for service) plan. They are not the same as Original Medicare coverage with a Medicare supplement plan, but they do offer a lot of flexibility. And, for people with excellent health who want full control, there are Medicare MSAs (medical savings account) insurance plans, too.
Can Medicare Advantage Plans Be Compared to Medicaid?
No, not really. However, there is a special type of plan, called Special Needs Plans (SNP), specifically designed for people who qualify for both Medicare and Medicaid. These plans are organized by the county and are offered by some of the biggest names in health insurance, including UnitedHealthcare, Humana, and Aetna, to name a few. If you have the option to get an SNP, do it! For those who qualify, it’s like getting free Medicare supplement insurance. You pay very little to see your doctor.
How Do I Enroll in a Medicare Advantage Plan?
Getting enrolled is easy. Once you know which plans you’re interested in, it’s time to get on the phone with a licensed insurance agent. Call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency.
Citations & References:
medicare.gov
- Find a Medicare plan
https://www.medicare.gov/plan-compare/ - Medicare Advantage Plans | Medicare
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/… - Medicare costs at a glance | Medicare
https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
cms.gov
- Trump Administration Drives Down Medicare Advantage and Part D PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ... for S…
https://www.cms.gov/newsroom/press-releases/trump-administration-drives-down-… - https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGe…
- Part C and D Performance Data | CMS
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGe…