Medicare Advantage

Medicare Advantage plans are also known as Medicare Part C. Part C plans offer the same benefits as Medicare Part A and Part B and can serve as an alternative to Original Medicare. However, before you can purchase a Medicare Advantage plan, you must have Medicare Part A and Part B.

Unlike Original Medicare, Medicare Advantage plans are offered by Medicare-approved private insurers. Though Part C plans must cover the same services as Medicare Part A and Part B, most plans provide additional services such as prescription drug coverage, fitness memberships, and dental and hearing coverage. 

Medicare Advantage plans are divided into different categories, each with its different features. Below are the types of Medicare Advantage plans.

Health Maintenance Organization Plans (HMO)

Health Maintenance Organization plans are a type of Medicare Advantage plan which provides the same services covered under Medicare Part A and Part B. In HMO plans, the medical services provided are limited to in-network healthcare providers. This means if you receive medical care from an out-of-network provider, you will cover the out-of-pocket costs for that service. HMO plans have a list of approved healthcare providers from which you can choose. You will most likely be expected to choose a primary care doctor from one of these networks and get referrals when you need to see a specialist.

HMO plans cover medical services such as home healthcare services, skilled nursing facility care, hospice care, and hospital insurance. HMO plans also cover Part B services such as durable medical equipment, preventive screenings, and outpatient medical procedures. Like many other Part C plans, most HMO plans offer prescription drug coverage, routine dental and vision coverage, and other benefits like fitness memberships.

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Preferred Maintenance Organization Plans (PPO)

Like HMO plans, PPO plans cover the same medical services as Part A and Part B and include extra services not covered by Part A and B.

PPO plans are sold by private insurance companies and offer more freedom than Health Maintenance Organization plans. Like HMO plans, PPO plans have a list of healthcare providers that are within the network. You can choose to stay in-network or visit providers outside the network. However, if you go out-of-network, you will pay more for the healthcare service. 

Also, under PPO plans, choosing a primary care provider is not mandatory, and you do not need a referral to see a specialist.

Private Fee-For-Service Plans (PFFS)

Private Fee-For-Service plans allow enrollees to visit any healthcare provider as long as they accept the terms of the Part C plan. This means there is no need to choose a primary care provider, nor do you need to get referrals for specialist visits.

Special Needs Plans (SNP)

Special Needs Plans are meant for individuals with certain health conditions and need specific healthcare services. SNPs cover the same services as Medicare Part A and Part B, in addition to extra services like prescription drug coverage. 

Medicare Medical Savings Account Plans (MSA)

Like all the other Advantage plans, MSA plans provide the same coverage as Original Medicare. It also includes additional coverage not provided by Original Medicare. MSA plans consist of a high deductible health plan and a savings account. Before receiving coverage from the plan, the high deductible must be paid. 

The plan also deposits money into the savings account that can be used to pay on the deductible.

Costs Involved

There are different costs included in a Medicare Advantage plan. If you register for a Part C plan, you must keep on paying your Part B premiums and other related costs to stay enrolled. Apart from the Part B premium, Part C plans have their monthly premiums, which can be as low as $0. However, there is an out-of-pocket maximum limit for Part C plans. This limits the costs you will cover for medical services. If you receive your care from in-network providers, then the maximum out-of-pocket limit in 2022 is $7,550. It is $11,350 for both in-network and out-of-network care combined.

Medicare Advantage plans can serve as a good replacement for Original Medicare as they also cover some services that are not covered under Medicare Part A and Part B. If you want additional coverage, then Medicare Advantage might be the right choice for you. To know more about Part C plans in Nebraska, call us today at 800-971-2989.