What is Medicare Advantage
Medicare benefits can be provided through an original Medicare plan or Medicare Advantage plan. A Medicare Advantage Plan can be either an HMO or PPO plan. Under the “original Medicare “ the government disperses the benefits. On the contrary under the Medicare Advantage Plans, Medicare pays private insurance companies to cover your Medicare benefits. The Best Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Medicare Part A benefits are hospital insurance . Medicare Part B benefits are medical insurance. However, most Medicare Advantage Plans offer Part A and Part B benefits and prescription drug coverage.
Benefits of Medicare Advantage Plans
Even though you have a Medicare Advantage plan, you are still responsible for paying the premium for Medicare Part B. The insurance company determines the Medicare Advantage plan premium. Most Medicare Advantage plan premiums are $0 a month. Nevertheless, the copayments are less with the Medicare Advantage Plan. As an example, let’s say your copayment under Medicare Advantage Plan to see your physician is $20 dollars. Under the original Medicare plan, the cost of the coinsurance is 35 %, which is more than $20. The Medicare Advantage Plan is designed to save thousands of dollars. For example, the Medicare Advantage plan has set limits to the maximum amount of out- of- pocket expenses . Once you have spent that out-of-pocket expense, your covered medical expenses are free for the remainder of the year. The original Medicare is quite different. Under the original Medicare plan, there is no cap on out-of-pocket expenses , which means that your potential expenses could constantly grow. Another essential benefit of Medicare Advantage Plan is that you can select a Primary Care Physician to help manage your health. By having access to a Primary Care Physician, this is not only a great asset to your health, but also a early intervention to any life-threatening ailments.
Best Medicare Advantage Plans
Options for Medicare Advantage Plan
There are currently 4 different plans for Medicare Advantage.
Health Maintenance Organization (HMO) Plan
An HMO plan requires you to get care and services from providers in the network. The only exception to this rule is services for the following : emergency care, out-of-area dialysis, and out-of-area urgent care. Moreover, this plan will require you to get a referral to see a specialist. It is critical to get approval from the insurance service before using certain services because you may be left with out-of-pocket expenses.
Preferred Provider Organization (PPO) Plan
This is a Medicare Advantage Plan (Part C ) that is offered by a private insurance companies. This particular plan has a group of network doctors, hospitals and health care providers that you can select and are covered financially under this plan. Expenses will rise drastically, if you choose to see a doctor that is considered to be an “out-of-network “ doctor. If you want prescription drugs covered under the PPO plan, you must join a PPO plan that offers this feature. Please remember if you choose a PPO plan that does not offer prescription drug coverage, you are ineligible to join a Medicare Prescription Drug Plan (Part D).
Private Fee-for-Service (PFFS) Plan
The sole purpose of this plan is to decide how much the insurance company will pay hospitals, healthcare providers and doctors. This plan also determines how much you will be responsible for paying for treatment to aforesaid entities. Moreover, under this plan, you are able to go to any Medicare-approved hospital, doctor, or healthcare provider. Please be mindful that not all Medicare-approved doctors will accept this insurance plan. Some PFFs cover prescription drugs and other plans do not. If your plan does not cover prescription drugs, you are able to add a Medicare Prescription Drug Plan.
Special Needs Plans (SNPs)
This plan only covers individuals with certain diseases and illnesses. This Medicare Advantage Plan is designed to fit the needs of the people in regards to, but not limited to : drug therapy, provider choices, and benefits that will alleviate financial burdens on these specific diseases. The only time you are able to receive care from doctors outside-of- network is to go to urgent care or out-of-area dialysis. This group has several specialists that can treat specific diseases. You can only join a SNP if you meet one of the eligibility requirements: cancer (not pre-cancer conditions), HIV/AIDS, End-stage liver disease, chronic heart failure, autoimmune diseases, certain mental health conditions, neurological disorders, stroke, dementia, ERSD, hematologic disorders, cardiovascular disease, or chronic alcohol problems. You will also qualify for this plan if you live in a nursing home or require home health by a nurse. Special needs plans are also equipped to help individuals with Medicaid and Medicare health insurance.
Best Medicare Advantage Plans
What insurance companies offer Medicare Advantage plans?
Aetna offers 2 plans Medicare Advantage:
- Medicare Advantage with Part D: This plan offers an HMO and PPO plan with prescription drug coverage
- Medicare Advantage Plan with no Part D: This plan is only offered as an HMO plan.
In addition to the different versions of Medicare Advantage plans offered, Aetna offers other added benefits. Aetna offers the following benefits to individuals with Medicare Advantage plan : Generic drugs for blood pressure, diabetes, and cholesterol have $ 0 copayment, free memberships to gyms, free annual exams, free hotline to licensed nurses 24 hours a day.
Blue Cross and Blue Shield
Under Blue Cross insurance, Medicare Advantage plans are referred to as “ Medicare Plus Blue “ plans. Blue cross offer the following Medicare Plus Blue plans:
- Blue Medicare Advantage Plus HMO
- Medicare Plus Blue PPO C. Blue Medicare Advantage Premier HMO
- Medicare Plus Blue PPO Vitality
- Medicare Plus Blue PPO Essential
- Medicare Plus Blue PPO Assure
- Medicare Plus Blue PPO Signature
Under the PPO plans, no referrals are needed to see specialists. In addition, most BCBS plans offer Medication Therapy Management Program, free gym memberships, preventative care for vision and hearing and wellness programs. The only disadvantage to choosing a Medicare Advantage plan under BCBS, is that different plans are offered for different states. It will be beneficial to talk to a BCBS agent in your state to help choose the best plan for your health needs.
Humana Medicare Advantage Plans
Humana offers HMO, PPO and PFFs plans for Medicare Advantage. For example, the Humana Gold Plus is an HMO that has provides annual screenings at no charge. This plan is very economical because cheaper copayments are offered to fit your budget. In addition, the Humana Choice PPO, provides access to doctors globally with no referrals. All Humana Medicare Advantage plans provide dental, hearing and vision benefits.
For more detailed information on Medicare Advantage, the different plans offered, benefits of Medicare Advantage , please visit www.Medicare.gov. This aforementioned website will help answer any additional questions about the Medical Advantage Plans. In close, what is Medicare Advantage ? Medicare Advantage is a great alternative to the original Medicare offered by the government. The Medicare Advantage plans previously discussed, not only cover medical and hospital costs, but most plans offer prescription drug coverage. These plans are designed to be affordable, offer more benefits, free annual benefits and availability in nearly all 50 states.