Medicare Advantage
Medicare Advantage (also called Medicare Part C or "MA" plans) are alternative plans to Medicare Part A and B that are provided by private, Medicare-approved companies. Importantly, MA plans may also include Part D prescription drug coverage.
What are Medicare Advantage Plans?
Medicare Advantage (also called Medicare Part C or "MA" plans) are alternative plans to Medicare Part A and B that are provided by private, Medicare-approved companies. Importantly, MA plans may also include Part D prescription drug coverage.
MA plans are available as HMO or PPOs:
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HMO (Health Maintenance Organization) - These plans typically require referrals from your primary care physician to see a specialist. Importantly, these plans do not provide out-of-network coverage except for emergency or urgent care. In other words, if you are traveling and seek non-emergency care from an out-of-network hospital or provider, your HMO plan will not cover these expenses.
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PPO (Preferred Provider Organization) - These plans allow you to see specialists without a referral from your primary care physician. Unlike HMO plans, with a PPO you can see out-of-network providers for non-emergency care, although there is typically a higher cost than when you see your in-network provider.
Why choose a Medicare Advantage plan?
MA plans cover a wide range of services including:
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Inpatient hospital care
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Skilled Nursing Facility (SNF) care
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Hospice
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Home Health care
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Outpatient doctor visits
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Preventive screenings (e.g. Cardiovascular and cancer screenings)
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Diabetes screenings and supplies
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Welln ess visits (e.g. flu and vaccinations)
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Certain ambulance services and transportation
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Maximum out-of-pocket limits
Additionally, many MA plans offer a wide range of extra benefits not provided by Original Medicare including:
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Dental
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Vision
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Hearing
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Fitness (e.g. gym memberships)
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Transportation to doctor's appointments
Maximum Out of Pocket Limit
Original Medicare (Part A and B), does not have a limit on your maximum out of pocket costs.
A Medicare Advantage plan caps your out of pocket costs at $7,550 per year (excluding those with end stage renal disease). Because Original Medicare does not include a maximum out-of-pocket limit, you could pay more than $10,000 or more for services.
What do Medicare Advantage Plans Cover?
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