Medicare Advantage

As you may know, Original Medicare covers only about 80% of your health care costs. The rest is your responsibility. Without Medigap insurance coverage, your out-of-pocket expenses can really add up. However, Medigap premiums can be very costly, especially for individuals on a fixed income.

Medicare Advantage Plans provide original Medicare benefits and more. They combine the benefits and flexibility of private insurance, with the predictability of controlled costs. You are still in the Medicare program with all the rights and protections you have under Original Medicare. These plans generally carry a low or $0 plan premium and you pay as you go.

What are Medicare Advantage Plans? As mentioned earlier, they are health plan options that are part of the Medicare Program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan; although you still have to pay your Part B premium. This coverage can include prescription drug coverage too. Medicare pays a set amount of money for your care every month to these private health plans whether or not you use services. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

There are three different types of Medicare Advantage plans:

Medicare Advantage Private Fee for Service (PFFS) has no defined provider network; however, that provider must accept the plan’s terms before you receive any services.

Medicare Advantage Preferred Provider Organization (PPO) has a contracted network of doctors and hospitals where you will receive most of your care. You may pay more if you go to a provider not in the network.

Medicare Advantage Managed Care is like a PPO, but you will typically need a referral for specialist services and to see doctors outside the network. You may pay more, or services may not be covered, when you get care outside of the network.

Medicare Advantage Plans with prescription drug coverage:

These plans have an option for prescription drug coverage that provides even more help with drug costs. If your Medicare Advantage Plan decides to offer Medicare prescription drug coverage and you want this coverage, you must take the drug coverage your plan is offering. Or, you can join another plan or return to the Original Medicare Plan and join a Medicare Prescription Drug Plan. If you are currently enrolled in a Medicare Advantage Plan, you will get information from your plan that explains your coverage options.