Medicare Advantage Plans
For those over 65 who feel that Original Medicare does not fully provide the coverage they need, a Medicare Advantage Plan could be the best solution. Private insurance companies, not the government, provide Medicare Advantage Plans. The plans feel more like the traditional insurance plans provided by your employers in the past. They are called Part C plans, but they cover parts A, B and D of Original Medicare and prescription supplements.
- The most common types are HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations) and PFFS (Private-Fee-for-Services) plans.
- You pay a deductible and/or copay for services (usually a fixed copay, like $15-20 per office visit).
- Your choice of doctors, hospitals and providers will be limited to those providers covered by your plan.
- You still have Medicare, but you are no longer in Original Medicare (OM). You have different costs, restrictions and premiums than OM.
- You may have to choose a Primary Care Physician, get referrals for specialist care, and get prior authorization for certain services.
- You can’t buy Medigap supplemental insurance to help you pay out-of-pocket costs.
- Unlike OM plans, Medicare Advantage Plans can include prescription drug coverage without supplements.
Plans must have out-of-pocket maximum limits. Once your maximum is met you pay nothing for the rest of the year.