What Is Medicare Advantage?
Medicare Advantage plans, also known as Medicare Part C, are medical insurance plans administered by private insurance companies. Medicare Advantage (MA) plans are paid a sum of money for each enrollee by the federal government. In turn, the insurance company pays for the cost of care and provides benefits based on rules set by the government.
Medicare Advantage Eligibility
To be eligible for Medicare Advantage (MA) insurance, you must be:
- Enrolled in Medicare Parts A & B (Original Medicare)
- Live within the Plan’s Service Area
Common Types of MA Plans
Common types of Medicare Advantage plans include:
- Health Maintenance Organizations (HMO)In most HMOs, you must see in-network providers to receive coverage, unless you require emergency medical treatment.
- Preferred Provider Organizations (PPO)In a PPO you can see any provider, but you generally pay more when seeing out-of-network providers.
- Private-Fee-For-Service (PFFS)Most PFFS plans have provider networks. You may pay less for your care when using in-network providers or facilities. All PFFS plans also must cover out-of-network care, but you may pay a higher cost.
You may also see these plans:
- Special Needs Plans (SNP)SNPs are designed to meet specific care needs, and you can only join a SNP if you fit the special needs category the plan serves. SNPs may provide care and coverage coordination services not offered by other types of Medicare Advantage Plan.
- Dual Special Needs Plans (DSNP) DSNPs are designed for Medicare beneficiaries who also qualify for Medicaid. In order for services to be covered under the plan, the provider must accept both Medicare and Medicaid. DSNPs may have either a PPO or HMO network.
Frequently Asked Questions
Does Medicare Advantage Include Dental Or Vision Coverage?
When can I change Medicare Advantage plans?
You will be automatically disenrolled from your previous Medicare Advantage plan, or Prescription Drug Plan. If you had a Medicare Supplement plan, you will still need to call and cancel coverage once your new coverage begins.
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