Medicare Advantage Plans: How Can They Help Me?

Medicare Advantage Plans are programs that provide eligible individuals with additional benefits outside of their regular Medicare benefits.  Medicare Advantage isn’t like traditional Medicare, which is handled by the government.  Instead, these types of plans are offered by private providers that have been approved by Medicare, and who must abide by strict rules in administering policies and handling patient claims.  It’s important to note that Medicare Advantage plans do not replace your original plan; instead, individuals still have regular Medicare when they sign up for this type of extra coverage through a private provider.

Sometimes referred to as “Part C” or “MA Plans”, the Medicare Advantage Plans have varying rules regarding out of pocket costs and different rules for how you receive services.  With Medicare Advantage plans, Medicare pays the companies providing the plans a fixed fee for your care, and the plan handles all of it’s own payments to the doctors and hospitals on their end.  In addition to coverage for treatment and services, Medicare Advantage policyholders typically receive prescription drug coverage (Part D) through these types of plans as well.  Participants are not allowed to have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan.  Those who do try to enroll for both will lose their Advantage Plan and will have to rely solely on their original Medicare program for prescription coverage.

There are a few different types of Medicare Advantage Plans, including Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans, Private Fee-for-Service (PFFS) plans and Special Needs (SNPs).  In general, you can apply for Medicare Advantage Plans if you have Medicare Part A & B, and if you live in the service area of the plan that you want to live in.  Be sure to check the eligibility requirements and costs associated with Medicare Advantage Plans before signing up in order to get the best coverage option for your needs.

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