Medicare Part C (Medicare Advantage Plan)

Medicare Part C is also known as Medicare Advantage. It combines both Medicare Part A and Medicare Part B and provides at least the amount of coverage as those plans, but often provides additional benefits at a lower cost. Medicare Part C coverage is provided by private insurance companies who are funded and approved by Medicare. Medicare Advantage Plans include four different types of plans.

  1. Preferred Provider Organization Plans (PPO)
  2. Health Maintenance Organization Plans (HMO)
  3. Private Fee-For-Service Plans (PFFS)
  4. Medical Savings Account Plans (MSA)

PPO plans have a network of doctors and hospitals that you can choose from, but you are also allowed to visit providers outside the network at a higher cost. You do not have to choose a primary care physician and you have the ability to choose any doctor, even specialists, without a referral. Some plans cover prescription drugs.

HMO plans also have a network of doctors, however, you can only visit doctors within the network and you must choose a primary care physician. You must have a referral from your primary care physician to see a specialist. If you choose to receive medical services outside the network, you’ll be responsible for paying the full cost. Some plans cover prescription drugs.

PFFS plans allow you to choose any doctor or hospital that’s been Medicare-approved as long as they agree to treat you and accept the plan’s payment terms. You do not have to choose a primary care physician or have a doctor’s referral to see a specialist. The plan has pre-determined rates for
doctors and hospitals and the amount you have to pay for services. Some plans cover prescription drugs.

MSA plans have two parts. There is a high deductible health plan and a savings account. Each year, Medicare funds the savings account with an amount to cover your coverage. However, the amount is less than your deductible which requires you to pay some out-of-pocket before the plan begins to pay for Medicare-covered services. You do not have to choose a primary care physician. Though you have the flexibility to receive health care from any doctor or hospital, your plan may have preferred providers that will provide services at a lower cost.

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