Medicare Advantage plans (or Medicare Part C) are health insurance plans approved by Medicare. Private health insurance companies administer and control the benefits. Medicare Advantage is not part of Part A and Part B, but if you enroll in the plan Medicare Advantage will offer at least the same benefits as Part and Part B. Many companies have different costs and coverage details attached to their plans. Medicare Advantage plans are very similar to an individual health plan. Medicare Advantage plans are available for people under the age of 65 who qualify for social security disability and individuals who are 65 and older.
Prescription coverage is included in most plans.
How do I Enroll in a Medicare Advantage Plan?
- In order to be eligible for Medicare Advantage, you must already be enrolled in Medicare Part A and Part B.
- Medicare Advantage plans are based on service areas. For example in the state of Indiana, the service areas are based on the state counties. If you want to purchase a certain Medicare Advantage health plan you must live in a county where the plan is available.
- Medicare Advantage plans have one other stipulation. The applicant cannot have End-Stage Renal Disease (ESRD).
Types of Medicare Advantage Plans
- Health Maintenance Organization (HMO): These type of plans offer a select group of health care providers and hospitals covered by the plan. In most plans you must choose a provider within the network or your health care costs would be out-of-pocket. Referrals from you primary doctor to a specialist may also be needed.
- Preferred Provider Organization (PPO): PPOs provider the insured more flexibility in choosing their health care provider. The plan still has doctors and hospitals inside a network, but the insured can choose to use any of the providers without a referral. If the insured choose to go outside the network they will usually have pay more.
- Private Fee-for-Service (PFFS): This plan chooses how much it will pay doctors, specialists, and hospitals. It also tells the insured how much they must pay when you get care. An insured can go to any Medicare-approved health provider or hospital that accepts the plan’s payment terms and agrees to give you care. Not all providers will.
- Special Needs Plan (SNP): Medicare SNPs limit membership to people with specific diseases or health characteristics. The plans are tailored to meet the specific needs of the groups of people that receive care. Most plans require the insured to get care from doctors or hospitals in the Medicare SNP network.