What is a Medicare Advantage Plan

Medicare Advantage Plan, difference between Original Medicare and Medicare advantage plans, Types of Medicare Advantage Plans and eligibility for applying Medicare Advantage plan?

Medicare Advantage Plan is also called as Medicare Part C or MA Plans. This Medicare Advantage Plans are offered by private companies, which will be approved by Medicare to provide you with all your Part A(Hospital Insurances) and Part B(Medical Insurance) benefits and these private companies must follow the rules set by Medicare. Medicare pays a fixed amount to these private companies to cover the Medicare benefits.

Original Medicare covers the Hospice care even if you have Medicare Advantage Plans. So it means Medicare Advantage Plans must cover all the services that original Medicare covers except Hospice care. Many Medicare Advantage Plans includes drug coverage and also offers extra benefits such as dental care, eyeglasses or wellness programs.

Let us see the difference between Original Medicare and Medicare Advantage Plans

                       Original MedicareMedicare Advantage Plans
Coverage
Medicare covers certain services and supplies in hospitals, doctors’ offices, and other health care settings. If you have both Medicare Part A(Hospital) and Medicare Part B(Medical) then you can get all of the Medicare covered services.

 

Medicare Advantage plans cover all of the services that original Medicare covers. Some of the Medicare Advantage Plans offer benefits like Vision, hearing or dental that Original Medicare does not cover.

 

Plans may include fitness and wellness benefits.

 

Costs
No limits to pay out of pocket expense unless you have supplemental coverageMedicare Advantage Plans will have a yearly limit on your out of pocket costs for medical expenses and should consider while choosing a plan. Once you will reach the limit, you pay nothing from your pocket for the rest of the year for the covered services.

 

Prescription Drugs
To get prescription drug coverage, you need to join Medicare Part D PlanMost of the plans include drug coverage. MSA Plans can’t offer drug coverage

 

Supplemental Coverage (Medigap)
You can add a Medicare supplemental insurance to pay your out of pocket costs like deductible and coinsuranceYou Can’t enroll in Medicare supplemental insurance if you are in Medicare Advantage Plan.

 

Travel
You have to buy supplemental insurance that offers travel coverage as Original Medicare does not cover care outside the United States.Usually won’t cover outside of the United States.

 

Doctor and Hospital Choice
You can take covered services with any doctor who accepts Medicare.Should go to the providers who participate in the plans network. Some Medicare Advantage plans offers even out of network coverage.


Different types of Medicare Advantage Plans

  • HMO – Health Maintenance Organization Plans
  • PPO – Preferred Provider Organization Plans
  • PFFS – Private Fee for Service Plans
  • SNPs – Special Needs Plans
  • HMOPOS – HMO Point of Server Plans
  • MSA – Medical Savings Account Plans

Who Can Join Medicare Advantage Plan?

Must have Medicare Part A and B and must live in plan service areas.

You can join Medicare Advantage plans even if you have Pre-existing condition except End Stage Renal Disease. People with End Stage Renal Disease can only join a Medicare Advantage Plan in certain situations.

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