Medicare Advantage Plans

Medicare Advantage Plans are a part of Medicare products that are offered by private companies authorized by Medicare. The plans provide you with the benefits enjoyed in Medicare part A and B. It can be said to be an alternative way of receiving original Medicare benefits. Medicare Advantage is sometimes referred to as Medicare Part C.

The common types of Advantage Plans include Private Fee-For-Service (PFFS) plans, Special Needs Plans (SNPs), Health Maintenance Organizations (HMOs), Medicare Savings Account, and Preferred Provider Organizations plans (PPOs). Most Medicare Advantage covers provide more services than those offered on the original medical cover. The payment, however, is not made under the original insurance. Services covered by Medicare Advantage but are not included in the normal Medicare insurance include dental services and drug prescription.

There are five typical Medicare Advantage Plans that are widely used. These plans have differences in costs, additional cover, and regulations for service delivery. Their availability also differs from one state or county to another. Smaller plans also exist despite them not being dominant in the market.

The Medicare Advantage plans include:

Medical Savings Account (MSA) plans: This is a rare type of coverage under Medicare Advantage. It is combined with a bank account to enable Medicare to deposit a particular amount of cash to clients’ accounts annually. The plan is highly deductible. You can use the money in the account to pay for health services within the year.

HMO Point of Service (HMOPOS) Plans: This plan has a slight difference to other plans under Medicare Advantage. It is a rare version of the HMO plan. With this plan, you can get your medical services out of the common network. It, however, attracts a higher charge for the same.

Major Types of the Medicare Advantage

The common types of Medicare Advantage that can be found in most locations include:

  • Health Maintenance Organization (HMO) Plans
  • Special Needs Plans (SNPs)
  • Private Fee-for-Service (PFFS) Plans
  • Preferred Provider Organization (PPO) Plans

Medicare Advantage Regulations

There are rules followed by the companies offering Advantage Plans to clients. Medicare pays a specific amount of money to these companies. The companies, on their part, have some rules and regulations to abide by. These rules are set by Medicare and are binding.

Medicare costs by different companies may vary. If you are covered under Medicare but decide to visit hospitals that do not offer the plans, you may be required to foot your medical bills from out of pocket. This is because some services are not covered under Medicare.

Some of the medical services that may incur different charges include:

  • Visiting physicians or suppliers that are not part of the urgent care
  • Visiting medical facilities that are not covered under Medicare

Services Covered Under Advantage Plans

Medicare Advantage covers all Medicare services. As such, you are assured of receiving all the services offered in part A and B.

Other services covered by Medicare include:

  • Hospice care
  • Part of clinical research studies costs
  • Emergency care

To enjoy the full benefits of the Advantage Plans, you need to check with your Medicare provider to ascertain that they offer all the services that you need. Some of the costs may not be covered under the program.

There is a provision for the advance coverage that guarantees you all the necessary services that you need medically. Once you take this plan, you will not be asked for any extra charges. Those that do not have the advanced coverage will be forced to pay for services not covered by their plans. Most commonly covered services under the Medicare Advantage include hearing, dental services, and general body wellness. Drug prescription usually falls under part C and requires a monthly payment.

Medicare Advantage Plans Charges

The charges vary from one plan to the other. Plans come up with the amount to be charged as premiums, service fees, and deductibles annually. This implies that the charges you pay may fluctuate on a yearly interval. The amount of money you pay this plan depends on a variety of factors.

  • The major factors include:
  • Whether the plan has any additional deductibles
  • If there is a monthly premium charge
  • The amount you are charged for each visit
  • The type of medical services you require
  • Whether the physician, supplier or facility you visit is within the Medicare network
  • Whether you have Medicaid or any aid from your state

The above factors determine how much you pay for your Medicare plan.

Drug administration in Medicare Advantage
Anyone with Medicare is entitled to drug prescription. Those who wish to decline will only be allowed to do so if:

  • They have additional help
  • Have other creditable insurance for drug prescription

With Medicare Advantage, you get your drug prescription through the plan. If this system does not work for you, you can opt for a different drug prescription plan. The advantage plans, however, have some restrictions. For instance:

  • Some plans cannot offer drug insurance, e.g., the Medical Savings Account plan
  • Some may not offer drug coverage by choice, e.g., some Private-Fee-for- Service plans.

Some plans like HMO and PPO do not allow joining of other medical covers. Once you enroll in another plan, you are deregistered and taken back to Medicare part A and part B.