Medicare Advantage Plans

What are they? Are they the right choice for you?

Basics: What are they?
With a Medicare Advantage Plan, every month Medicare pays a set amount of money for your care to a private health plan that manages Medicare coverage for its members. Your planned premium for this coverage is generally much less than a traditional Medicare Supplement, but you’re subject to co-pay amounts.

Types of Medicare Advantage Plans:
There are different types of Medicare Advantage Plans, including:

  • HMO’s – Network of providers. You choose a primary physician and referrals are generally required for specialists. You must also utilize provider services within the network.
  • PPO’s – Network of providers. You choose a primary physician, but referrals are generally not required to see a specialist. However, the specialist must still be part of the network. If you choose to see a provider outside of the network, you may do so, but you will be required to pay a higher co-pay amount.
  • PFFS (Private Fee For Service)No Network of providers. No referrals needed. The provider must agree to accept payment from your plan.

When you utilize the hospitals and doctors visits, each plan’s co-pay will vary. Many of these plans will also have an out-of-pocket maximum that you pay each year, therefore, capping your expense each year. These plans are also guaranteed issue to anyone eligible. (Except if you have end stage renal failure)

Are they right for you?
Medicare Advantage Plans definitely look attractive, but it’s not an easy decision, and there are things you need to be aware of when enrolling in a Medicare Advantage Plan.

If you’re healthy, these plans can probably save you quite a few dollars, but if you utilize Medical Facilities often, they could be more costly than a traditional Medicare Supplement Plan.

If you currently do not have or cannot afford a Medicare Supplement policy then this is a Wonderful Option for you. If you are a Veteran utilizing the VA providers, then, again this is a Wonderful opportunity to add to your present benefits because this plan does not interfere with your VA Benefits at all – it will only enable you to add to your options.

As previuosly indicated, it is not an easy choice. There are a lot of factors to consider. If you have questions or would like someone to explain more to you about the Medicare Advantage program, please call 1-800-642-3490 and ask for Pam or, send us a message.