A Medicare Advantage Plan, according to the Centers for Medicare and Medicaid (CMS) is defined as:
Health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program.
With Medicare Advantage Plans:
- You generally get all your Medicare-covered health care through that plan.
- Coverage can include prescription drug coverage (with a MA-PD).
- You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
- You may have lower out-of-pocket costs than the Original Medicare Plan.
- You may have to use the plan’s doctors and hospitals to get services.
You don’t need to buy a Medigap policy (do not cancel your Medical Supplement until after you are enrolled in a Medicare Advantage Plan).
A Medicare Advantage Plan must cover all medically necessary services found under Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). However, a Medicare Advantage Plan can have a different cost-sharing system as compared to Original Medicare. You may be charged different co-payments (for example, $10 to $30 for a primary care doctor visit for Medicare-covered benefits) or co-insurance (30% Out-of-Network cost for durable medical equipment) or deductibles.
Medicare Advantage Plans are offered in different forms, such as:
- Health Maintenance Organization (HMO)
- Health Maintenance Organization with a Point of Service Option (HMO POS)
- Preferred Provider Organization (PPO)
- Private Fee-For-Service (PFFS)
- Medicare Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSAs)
Do you have another question that we have not answered? Click here to let us know.
(source: Medicare.gov and Q1Medicare.com Online Team)