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The Basics of Medicare Part C or Medicare Advantage Plans

Some seniors who want more coverage prefer to purchase one of the Medicare Advantage plans. The changes to how they are structured can affect millions of people. Seniors in the US enrolled in Part A automatically when they turn 65. Medicare Part A deals with hospitalization costs. Typically, there is no cost for Part A.

Does Medicare Cover the Silver Sneakers Program?Part B, on the other hand, deals with the costs of office visits. Unlike Part A, you may have to pay for its premium.

Another Medicare plan is Part D. It is a drug prescription program that handles your medication cost. The coverage will depend on the kind of plan you pick. The rule of thumb here is to pick a Part D plan that covers most of your medicines.

Medicare Advantage bundled Parts A and B into one plan. Some Part C plans have a built-in Part D program. One of the advantages of having an MA plan is that it combines some of the complicated elements of Medicare and rolled them into one plan. Furthermore, the plans are typically less expensive than when you pay for Part B and D separately.

However, the overall cost and terms hinge on the geographic area where you live and the details of your plan. There are variations on the basic Medicare Advantage plans. However, they are organized into five types.

 

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Health Maintenance Organization (HMO)

HMO plans are the most popular options since the 1970s. This type of plan groups insurance and provider services into one structure. Recipients of HMO plans can go to a network of healthcare providers, like pharmacies, hospitals, and clinics to receive treatment.

If you enroll in an HMO plan, you will pay less than if you choose other types of plans. The costs are in-network. In that case, there is no need for you to negotiate your payments compared to going to outside parties.

Medicare Supplemental InsurancePreferred Provider Organization (PPO)

This plan is more expensive than HMO. But it offers low-cost access to a network of providers. These providers are under contract with the PPO. If you choose a PPO plan, you don’t have to choose a primary care physician to handle all of your medical care. You can easily seek a specialist without having to seek a referral from your primary doctor.

With such flexibility, PPO comes with a high price. According to Kaiser Family Foundation in 2019, drug plans for Medicare Advantage recipients averaged $23 per month for seniors with HMOS but local PPO premiums reached $39. Then, for regional PPOs, seniors are charged $4 per month for the same coverage. However, PPO subscribers can save money on their drug purchases when they shop for less expensive drug stores, instead of going to in-network outlets.

 

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Private Fee-for-Service

PFFS is a diverse group of health plans. However, the plans can offer you more flexibility because of how the benefits are structured. The plans work like PPO. That is, the PFFS providers have a network of practitioners. These practitioners agreed to treat plan members. If you can pay more, you can choose to visit a practitioner outside of the network.

Aetna Medicare Advantage PlansPFFS plans don’t follow Original Medicare guidelines. In that case, the plan you pick might charge you more or less compared to other Advantage policies. You can also purchase standalone prescription coverage if you want. This is not allowed with other types of coverage.

Is PFFS a great plan for you? It really depends on your overall health and your medical needs. But it can be an excellent option for managing your costs.

Any PFFS plan can shift some of the costs to higher monthly premiums. You can also obtain a plan with higher point-of-service expenses or limited coverage for those rare services, like specialist care. Nonetheless, it can be an ideal option if you are in good health as you only have to pay for the policy’s co-pay if you undergo a certain service.

Special Needs Plan (SNP)

Its benefits are targeted for people with special needs. Special needs patients are categorized into three groups. The first one is a group of institutionalized people. Then, there is a group of individuals with disabling medical conditions. Lastly, there is a group of dual-eligibles. They meet both criteria.

SNPs are designed to be a coordinated care plan. They meet the guidelines of Medicare. And they must offer a prescription drug program. These plans can be offered by HMOs or point-of-service policies.

Medicare Medical Savings Account

MSA plans are considered health savings accounts the can cover a high share of the cost of a high deductible health plan. If you enroll in any type of high deductible plan, you can save a lot of money on your monthly premium with MSA.

But the savings come with a cost. That is, you will pay expensive care when you need it. In that case, this plan is an attractive option if you are in good health and you don’t need coverage for medical emergencies.

A component of MSA is a Medicare Advantage plan. It combines a high deductible plan with a bank account at a certain institution. Your insurance provider will choose the banker.

The provider will deposit a lump sum in your bank account every year to handle all authorized medical deductibles. The overall amount is less than the entire cost of deductibles. But it leaves you responsible for the remaining of your cost of care. The deposits are tax-free. But they should only be spent on approved medical care.

 

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Frequently Asked Questions

What Medicare Advantage Plans Cover?

They cover all items in Original Medicare. However, you can get those benefits from private health insurance. Many health insurance companies can offer you a plan that combines the benefits of Part A and Part B into one plan — Part C. You may also find a plan with Part D prescription drug program. Plus, some carriers can give you coverage that is beyond what Medicare can offer you, like gym memberships.

Who can Enroll in a Medicare Advantage?

You are eligible for this plan if you are a US citizen. However, you must have an active Original Medicare to qualify for it. Furthermore, some policies are only accessible in some states But all 50 states, Puerto Rico and District of Columbia will have some coverage.

What is the Best Way to Find Medicare Advantage Plans in My Area?

You can go to the official Medicare website to find more information about Medicare Advantage plans. Or you may choose to visit the official websites of the health insurers. Some of them list their plans online.

And if you need to compare Medicare Advantage plans, you may use our website to get quotes and compare the rates.