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Medicare Advantage

Medicare Advantage plans are alternatives to Original Medicare and are sold by private insurance companies. They cover all the benefits under Original Medicare and cover extra services that include, but are not limited to prescription drugs, dental, hearing, and vision care.  

To enroll in a Medicare Advantage plan, you must first be enrolled in Original Medicare.

Types of Medicare Advantage Plans

Health Maintenance Organization Plans: HMO plans typically limit their coverage to in-network healthcare providers. This means there is a list of health providers to choose from, but you may cover all the out-of-pocket costs for the services if you choose to receive care out-of-network. These plans may also require you to select a primary care physician from one of their networks and get referrals when a specialist is needed.

Preferred Provider Organization Plans: PPO plans offer more flexibility than HMO plans but at a higher cost. Though each PPO plan has a list of in-network providers, you will typically have the option to get healthcare services from out-of-network providers. However, you will pay more for these services but will still get more coverage than you would with an HMO plan. Also, you don’t need a referral to go to a specialist, nor are you required to choose a primary care physician.

Private Fee-For-Service Plans: This type of Medicare Advantage plan allows you to keep or choose any healthcare provider as long as they accept the terms of your Medicare Advantage plan. You won’t be required to choose a primary care physician or get referrals to visit a specialist. However, this plan will decide how much they will pay for your services, as well as how much you will pay.

Special Needs Plans: Medicare Advantage Special Needs Plans are available to individuals with chronic health conditions and specific healthcare needs. These plans will cover everything that Original Medicare does, and they are required to provide prescription drug coverage. The three types of Special Needs Plans are:

  • Chronic Condition Special Needs plans.
  • Institutional Special Needs plans.
  • Dual Eligible Special Needs plans.

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