Medicare Advantage

Medicare Advantage Plans are an alternative to Original Medicare. Sometimes referred to as Medicare Part C, Medicare Advantage Plans are alternatives offered by private insurers that follow Medicare guidelines. While all Medicare Advantage Plans must cover Medicare Parts A and B, some Medicare Advantage Plans also cover Part D, prescription drug coverage. Some also cover additional benefits that Original Medicare does not, like dental and vision benefits.

Types of Medicare Advantage Plans

There are six different types of Medicare Advantage Plans. They are:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs)
  • HMO Point-of-Service (HMOPOS)
  • Medical Savings Account (MSA)

Each of these plans has different reimbursement models. 

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Benefits of Medicare Advantage

The people who choose Medicare Advantage plans are often looking for coverage for services that Medicare does not cover. For example, many Medicare Advantage Plans offer vision, hearing, dental, and gym memberships, while Original Medicare does not offer any. The Advantage Plans may also include prescription drug coverage, eliminating the need for Part D purchase. 

There are other individuals who need chronic-care coverage or transportation needs. Some Medicare Advantage Plans will cover these needs.

Costs of Medicare Advantage Plans

While the cost of care differs depending on the plan, there are some general similarities to Medicare Advantage Plans. Depending on the plan, you may pay for any of the following:

  • Monthly premium
  • Yearly deductible
  • Copayments or coinsurance
  • In-network vs. out-of-network providers
  • Extra benefits
  • Yearly limit on out-of-pocket expenses
Is Medicare Advantage worth it?

Medicare Advantage Plans are a good option for anyone who feels that their healthcare needs may be better met by a private plan rather than by Original Medicare. The benefit of these plans is that many offer additional benefits compared to Original Medicare. The downside is that these benefits may cost more, and you may be limited to a smaller network.