Medicare Advantage Plans, also referred to as Medicare's "Part C" option, are private insurance companies approved by Medicare to provide Part A (hospital insurance) and Part B (medical insurance) coverage.
Some plans - particularly, health maintenance organizations (HMOs) - may require you to see doctors who belong to the plan, or to go to certain hospitals for services. For some Medicare beneficiaries, these plans offer co-payments lower than Original Medicare (Part A and B), and provide additional benefits. However, if you join a Medicare Advantage Plan, you can't use a Medigap policy to help cover costs.
Types of Medicare Advantage Plans:
Medicare Health Maintenance Organization (HMOs)
Available in some areas of the country, HMO plans cover all Medicare Part A and Part B health care. Some cover extra benefits (e.g., extra hospital days). In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list, except in an emergency. Costs may be lower than the Original Medicare Plan.
Preferred Provider Organizations (PPO)
With a PPO, you may pay less for your healthcare expenses if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Private Fee-for-Service Plans
This type of plan allows you to go to any Medicare-approved doctor or hospital that accepts the plan's payment. The plan, rather than Medicare, decides how much it will pay - and what you will pay - for services you receive. You may pay more or less for Medicare-covered benefits. These plans also may offer extra benefits Original Medicare doesn't cover.
Medicare 'Special Needs' Plans
This plan provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary by state.
To compare Medicare Advantage Plans, go to the Medicare Options Compare tool on Medicare's website. Or, ask your Health Mart pharmacist for advice, and to find out:
- Which Medicare Advantage Plans offer prescription drug coverage (most do)
- If those plans cover the drugs you need
- If those plans are honored at your Health Mart pharmacy (most are). Or, click here now to see if your insurance plan is covered by Health Mart
- Whether you should choose Medicare Part D to cover your prescription drugs, instead of the Medicare Advantage Plan's drug coverage
