Medicare Advantage Plans, also known as “Part C” plans, are Medicare-approved health insurance plans. MA plans provide the same coverage as the original plan, but with additional benefits that the original plan did not include.
Medicare Advantage Plans make sense only if you are already enrolled in Plans A and B. If you are not enrolled in Plan A or Plan B, you will not be eligible for Medicare Advantage Plan benefits at any time.
Medicare Advantage Coverage
Besides offering the same coverage as Original Medicare, some of the extra benefits include:
- Prescription drug coverage
- Gym memberships
- Wellness programs
- Nutrition programs
- Transportation for doctor appointments
- Dental, vision, and hearing coverage
Medicare Advantage Plans
Medicare Advantage Plans available in a variety of sizes and shapes:
- HMO: Health Maintenance Organization (HMO) plans generally require the policyholder to select a primary care physician from the plan’s provider network. The plan also requires referrals to see a specialist. Unless it is an emergency, if the beneficiary receives healthcare outside of the plan’s network, the plan will not reimburse the expenses of the services received. In addition, HMO plans offer a lower premium payment.
- PPO: Preferred Provider Organization (PPO) plans don’t need referrals or primary care doctors. They also do not limit the user to a certain network of providers. However, there is a high premium because of the flexibility.
- PFFS: Private-Fee-For-Service (PFFS) plans do not require referrals or primary care physicians, and they may also allow beneficiaries to receive care outside of the plan’s network. The insurance company selects what it will pay your provider and what you will pay for a healthcare service under PFFS Plans.
- MSA: Medical Savings Account (MSA) Plans combine a high-deductible plan with a savings account to pay for medical expenses. The beneficiary must pay the high deductible in full for receiving coverage. The plan provider will deposit a specific amount into the savings account each year that can be used to cover the deductible. The amount deposited, on the other hand, will always be less than the deductible. The beneficiary is unable to deposit money into the account.
- SNP: Special Needs Plans (SNP) are designed and confined to a certain group of persons having specific conditions or illnesses. An SNP may require the beneficiary to choose a primary care physician, receive referrals to specialists, and only receive care or treatment within the plan’s network. Prescription coverage is provided by all SNPs.
Contact Galina-Balboa Global Insurance Group to discover more about your options and which Medical Advantage plans are available in your area.
Contact us for a consultation regarding your insurance needs.