Medicare Advantage Plans: Advantages?
Medicare Advantage Plans are NOT Medicare Supplements. Medicare Advantage Plans are not always advantageous either, although they can have lower premiums and extra benefits not found in Supplemental policies. They work differently from Original Medicare that is supplemented by a Medicare Supplement policy. There are different types of Advantage Plans too. It is very important to know that not all doctors or hospitals will accept all Medicare Advantage plans. Some accept none. Although Medicare Advantage Plans are health plan options that are part of the Medicare program, they are different from original Medicare plus a Supplement. If you join one of these plans, you generally get all your Medicare-covered health care through that company's plan instead of through Original Medicare. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans (PFFS)
• Medicare Special Needs Plans
Some Advantage plans use a PPO (Preferred Provider Organization). In PPO Plans doctors who are part of the PPO have signed a contract agreeing to accept the PPO payment schedule. Generally, these plans do not pay the same for doctors and hospitals that are out-of-network. Some plans are HMO (Health Maintenance Organization). In an HMO Advantage Plan, there is no coverage unless a doctor is part of the HMO. Private Fee for Service Plans (PFFS) do not use any provider networks with contracted doctors or hospitals at all. So a doctor's acceptance of a PFFS plan is on a case-by-case and visit-by-visit basis. As you can see, it is critical that you talk to your providers before signing up for any Advantage plan. On the other hand, Medicare Supplement plans will work with any doctor or hospital who accepts Medicare Assignment (a provider who accepts Medicare assignment agrees to accept Medicare's "approved amount" as full payment for the covered services. Doctor's who don't accept assignment are limited by law in how much more they can charge. Modernized Supplement Plans G and F cover 100% of doctors' "excess charges").
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy. (Much of the above comes from http://www.medicare.gov/Choices/Advantage.asp)
**Please take note that there are some things to be aware of with Medicare Advantage plans. These plans often have much lower premiums than Supplements (this is because the company receives your part B premium in addition to other funds from the government when you enroll). However, these plans are not accepted by all doctors. It is very important to check with your doctors and hospitals prior to enrolling in a Medicare Advantage plan to be sure they will accept them. For people who cannot qualify for a Medicare Supplement policy because of health problems, or their premium is unmanageable and they do not qualify to move to a lower cost supplement because of health conditions, a Medicare Advangtage plan may be the most appropriate choice since there is less underwriting for Advantage plans. There are certain enrollment periods during which someone can enroll and disenroll. So a person is not free to come and go from the plan at will. For details contact your local Area Agency on Aging, 1-800-MEDICARE, or a company offering Medicare Advantage plans in your area.
Call (888)336-5351 if you have questions we can answer.