Medicare Advantage Plans are known as Medicare Part C. Medicare Advantage Plans are health plan options approved by Medicare and run by private companies.
A plan combines coverage for hospital stays with coverage for doctor visits.
A plan can include Part D prescription drug coverage (often at no additional premium).
The plan coordinates health care through a primary care physician who manages the care received from specialists and hospitals.
The plan is paid a specific amount each month by Medicare for an individual covered by Part A and B who selects a Medicare Advantage Plan.
A plan has a service area.
A plan must cover the same services as Part A and B except the plan does not cover hospice care. Hospice care is provided by original Medicare A coverage.
An individual will continue to pay a Medicare Part B premium. The Medicare Advantage plan may also charge its own premium and the premiums, if charged, vary.
A plan may charge deductibles.
Most plans charge co-payments.
Each plan sets own terms about co-insurance.
The plan may require an individual to choose specific doctors and hospitals.
NOTE: Medicare Part A and Part B allows an individual to visit any doctor or hospital that accepts payment from Medicare.
A plan may provide annual check-ups, shots, fitness programs and extra benefits, such as vision, hearing and dental.
A plan may offer nurse helplines and other resources that help an individual to take a more active role in the individual’s health care.
The plan can change premiums and co-payments from year to year.
The plan may change health care providers (doctors and hospitals) who join and leave the plan’s network.
These plans allow more freedom to choose a doctor.
The plan does not require an individual to choose a primary care doctor.
The plan has network doctors and hospitals but can also use out-of-network providers for covered services, usually for a higher cost.
The plan normally does not require a referral to see a specialist.
The plan may offer extra benefits for an additional premium.
The plan may include prescription coverage.
The plan may include prescription coverage.
The plan generally requires that an individual must see a primary care doctor to get a referral to see another health care provider.
Exceptions: yearly mammogram screening, in-network pap tests and pelvic exams (every other year).
The plan requires that an individual must get care and services from doctors/hospitals in network.
Exception: Plan has Point-of-Service option, an individual can go out-of-network, although it will cost more.
The plan permits an individual to choose another doctor in the plan if an individual’s doctor leaves.
The plan may require an individual to pay full cost of services if care is received outside the plan’s network.
The plan may offer extra benefits for an additional premium.
A plan is run by a private company.
A private plan may not include prescription coverage, an individual can join a Part D plan.
The plan does not require an individual to choose a primary care doctor.
The plan permits an individual to receive services throughout the U.S.
A plan may offer a broader choice of covered services and additional services, such as check-ups or other preventative care.
The plan permits an individual to go to any Medicare-approved doctor or hospital provided the provider agrees to the plan’s terms and conditions.
These plans aren’t the same as the Original Medicare Plan and have different rules from other Medicare Advantage Plans.
An individual must make sure before joining a PFFS plan that doctors, hospitals and other types of providers are willing to accept the plan’s payment terms.
A Medical Savings Account (MSA) plan allows an individual to manage a health care allowance. An individual can manage medical spending by paying a substantial portion of health care costs out-of-pocket, letting the funds in an MSA accumulate tax-free. MSAs are new and not yet available everywhere. Pennsylvania does have MSA plans.
This is how an MSA plan works:
An individual selects an MSA plan.
A special MSA account is set up with a bank selected by the MSA plan.
The individual pays a monthly Medicare Part B premium.
Medicare pays the MSA plan a specified amount. The MSA deposits the specified amount into the special MSA account.
An individual can pay for health care services out-of-pocket or out of money in MSA account.
NOTE: An individual is still subject to an annual deductible.
The money in an MSA accumulates for future health care costs if the money is not used.
These are care management plans that coordinate health care for people with special health care needs. These plans are run by private companies and create a network of doctors and hospitals to provide care.
The plan must provide Medicare prescription drug coverage.
Most plans serve individuals in an LTC facility.
Many plans require that an individual must be eligible for both Medicare and MA.
Some plans require that an individual must have certain chronic or disabling conditions.
Examples: diabetes, congestive heart failure, mental illness or HIV/Aids.)
The plan may require a primary care doctor as a care coordinator to help an individual with a personal care plan to coordinate care.
The plan generally requires that services are received from doctors or hospitals in the plan’s network (except emergency or urgent care).
Updated February 14, 2012, Replacing March 3, 2011