Medicare Advantage Plan

Medicare Advantage, which is also called Part C or MA Plan, is an additional option for choosing a Medicare plan. These plans are offered through private companies that have been approved by the CMS (Center for Medicare & Medicaid Services). Medicare Advantage plans offer the same amount of services as Original Medicare, plus more.

What does it cover?

With a Medicare Advantage plan, it includes additional benefits not provided with Original Medicare, which may be appealing to many consumers. Some of the benefits include the following:

  • All Medicare Part A & B benefits
  • Prescription drug coverage
  • Periodic dental care
  • Coverage for hearing aids and tests
  • Annual eye exams
  • Memberships to fitness centers and wellness programs
  • Ability to choose plans with and without provider networks (Source)

Types of Plans

There are several types of plans offered within Medicare Advantage that you can choose from. Most Medicare Advantage plans are considered coordinated care plans. Coordinated care plans consist of provider networks that allow consumers to pay less out-of-pocket expenses for healthcare. Listed below are the MA coordinated care plans.

  • Preferred Provider Organization (PPO) plan – This plan provides coverage to healthcare providers both inside and outside of the network. PPO plans will cover a portion of the costs for consumers that choose to use an out-of-network provider.
  • POS (POS) plan – POS plans allow consumers to pursue medical care outside of their provider network under certain circumstances.
  • Health Maintenance Organization (HMO) plan – A HMO plan utilizes a primary care provider within the network to coordinate care for a plan member. HMOs will only cover the costs for providers in the plan’s network.
  • Special Needs Plans (SNPs) – This is a plan that provides coverage to individuals with certain disabilities that require special healthcare. There are different types of plans with SNPs that align with the special needs of plan members.
    • Institutional Equivalent Special Needs Plans (IE-SNPs)
    • Dual-Eligible Special Needs Plans (D-SNPs)
    • Chronic Special Needs Plans (C-SNPs)
    • Institutional Special Needs Plans (I-SNPs)

What are the differences between Original Medicare and Medicare Advantage?

While both plans share many similarities, such as the inclusion of Medicare Parts A & B, there is a lot of distinction between the two. One major disparity is prescription drug coverage. With Medicare Advantage, most plans will provide full coverage of prescription drugs. With Original Medicare, there is limited coverage, as it typically doesn’t cover any prescriptions a plan member would take at home. As mentioned earlier, Medicare advantage provides additional benefits that Original Medicare doesn’t offer within its plan.

Choosing the Medicare Advantage plan may be the best choice for Medicare members looking for more benefits and coverage outside of their provider network. Be sure to speak with a Medicare Advantage plan representative to ensure you’re eligible and within the area of its coverage.