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What is a Medicare Advantage Plan? (Medicare Part C)



You may wonder: What is a medicare advantage plan and how is it different from original medicare?


Well, Medicare Advantage Plans are a type of Medicare health plan offered by private insurance companies. The government sets rules and guidelines for private insurance companies on how to sell and administer these plans. Medicare pays the insurance company to administer your Part A and B benefits through the Medicare Advantage plan.

While all plans must cover the same services as Parts A and B, different Medicare Advantage plans will have different networks, copays, and drug formularies.

There are different types of Medicare advantage plans. The two most popular are:

Health Maintenance Organizations (HMOs). HMOs have closed provider networks and you generally must get all but emergency care within your plan’s network. You choose a primary care doctor who oversees all your medical care. Your plan may require you to get a referral for specialist care and prior authorization for certain tests and procedures. HMO Plans almost always include Part D prescription drug coverage.


Preferred Provider Organizations (PPOs). These plans also have provider networks, but you can still use any provider that accepts Medicare. However, you’ll pay a lot less out-of-pocket if you see a doctor that is in your plan’s network. You don’t have to choose a primary care doctor or need a specialist referral. Most PPO plans also include Part D coverage.


In order to join a Medicare Advantage plan you must :

Live in the service area of the plan you want to join

Have Medicare Part A AND Part B

Do not have End-Stage Renal Disease (ESRD) ( New changes coming in 2021 may allow people with ESRD to enroll in Medicare Advantage plans)


As mentioned earlier, Medicare advantage plans must at least cover the same services as Parts A and B (Original Medicare). In addition, Medicare Advantage plans can include Prescription drug coverage, which is not offered under original medicare. Most Medicare Advantage plans also offer extra benefits such as routine vision or dental services, routine hearing services, membership in fitness programs, and more.


One of the many benefits of medicare advantage vs. Original Medicare is the limit on the annual maximum out of pocket spending. Under the original medicare, there is NO maximum spending limit for medical expenses. This means your cost for medical services can add up and turn into a huge financial debt.


Medicare Advantage plans are a great choice for a lot of medicare eligible members. Ask your agent about the tips and tricks for saving money when you have a medicare advantage plan. You will need to be aware of things like copayments and the plan’s network of doctors and hospitals that may make a medical advantage plan different from the insurance coverage you currently have. If used right, a medicare advantage plan may save you big money on your out-of-pocket health care expenses.


Want to learn more about your Medicare options? We are here to help. Call us today at (540) 662-4432 to speak with Brian or one of our Insurance agents or visit our website www.medicaretrustedagents.com to obtain more information.

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