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Providing Healthcare Solutions to Seniors

Medicare Advantage

What is Medicare Advantage Plan?

An option you have being Medicare Eligible is to sign up for a Medicare Advantage Plan – also known as Part C.  This is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.

Things to consider:

  • Under an Advantage plan you will receive the same benefits you would receive under Medicare Part A & B.  In many cases, the benefits are better!  
  • It is important to note you do still need to pay for your Part B Premium.
  • There may also be a premium for your Medicare Advantage plan – there certainly are some plans that have no premiums at all!
  • There are 6 different types of Medicare Advantage plans – see below for an explanation of the different types.  Not all plans are available.  Availability of plans depends on your service area which determined by your zip code.
  • These plans do have out of pocket costs such as co-pays, coinsurance and deductibles but on there is an annual limit on your out-of-pocket costs.  These limits can be extremely reasonable but can also reach some significant levels.  Some we have seen range from $1,800 to $6,000.  Once you reach this limit however you’ll pay nothing for covered services!
  • It is important to understand what Medicare Advantage plans are available in your area.  It is also important to understand that typically you are subject to a plan’s network of providers.  This means that in some cases your existing providers may not be in the network. Providers can also join and or leave a network anytime during the year.  The out-of-pocket limits mentioned above can also change each year so it is vital that during open enrollment you check on your plan to ensure you have the most cost effective plan.

How can we help you? 

There are quite a few questions you need to answer before you choose a Medicare Advantage plan and we are more than happy to walk you through the process of making a great decision.We also offer our clients an annual review of their plan during the various enrollment periods and are always available to answer any questions you have about your plans.

We are contacted/certified with several insurance carriers to represent their Medicare Advantage plans.  This means we can offer you are broad look at all available plans in your area to ensure you are getting the right plan for YOU.  

Different types of Medicare Advantage plans:

Health Maintenance Organizations (HMO) Plans: This is an in-network plan.  You will must go to the in-network doctors, specialists and hospitals to receive coverage.  In many cases under an HMO plan you will need a referral from your primary Care Provider to see other doctors or specialists.

Preferred Provider Organization (PPO) Plans:  This type of plan offers lower costs if you use doctors’ specialists and hospitals that belongs to the plans network.  You can go out of network but may be subject to higher costs.  

Private Fee-for-Service (PFFS) Plans:  You can go to any doctor that accepts this plans payment terms.  This plan will determine how much it will pay doctors and other providers for services and how much YOU will pay when you receive care.

Special Needs Plans (SNPs): These plans are specialized plans for people.  People who are on both Medicare and Medicaid, people who live in a nursing home or have certain chronic medical conditions.

HMO Point of Service (HMOPOS) plans:  These plans are HMO’s that may allow you to go out of network to get services

Medical Savings Account (MSA) plans:  These plans have a high deductible combined with a bank account.  Medicare deposits money into your account.  You use the money to pay for your Healthcare.  These plans do not include prescription drugs – you would need to get a separate prescription drug plan (Part D)