Medicare Advantage - Medicare Advantage Plans

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 sometimes Medicare Part D Prescription Coverage. These plans provide at least the amount of coverage as those plans, but often provides additional benefits at a lower cost.

Medicare Advantage Plans are provided by private insurance companies who are funded and approved by Medicare.

Medicare Advantage Plans include four different types of plans.

Preferred Provider Organization Plans (PPO)
Health Maintenance Organization Plans (HMO)
Private Fee-For-Service Plans (PFFS)
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.

Medicare Advantage Plans - Changing in 2010

Medicare Advantage Plans will change dramatically beginning January 1st, 2010. Thousands of individuals who have obtained these type of plans from leading carriers including Blue Cross, Coventry, and WellCare will no longer be covered and will be forced to purchase similar plans from other insurance companies. In addition, people who will still be covered under their current plans will likely notice increased monthly premiums and less benefits! Everyone across the nation is asking the same question…. What do we do now?

There are several options for people who are losing coverage or are unhappy with their increased premiums. The first option is to find a Medicare Advantage plan similar to the one you currently have, but with a different insurance company. The best way to accomplish this daunting task is to consult an insurance broker who represents multiple companies. These types of brokers can be a valuable resource and can help you find a plan that is both affordable, and offers great benefits.

The second option is to enroll in a Medicare supplemental insurance plan. Medicare Supplement plans tend to provide greater benefits for hospital and medical services and often have lower out of pocket costs than Medicare Advantage plans. In addition, Medicare supplement plans can be cheaper than many Medicare Advantage plans in 2010. This option is very popular because seniors can purchase a more affordable plan with better coverage! Once again, people choosing this option should consult with an insurance broker who represents multiple insurance companies to ensure they purchase the most affordable plan from a quality company. Keep in mind Medicare Supplement plans are standardized by Medicare, meaning insurance companies charge different prices for exactly the same coverage!

Although Medicare Advantage plans have cost and coverage benefits, they also have serious drawbacks. The number of available providers you can see may be the biggest problem with these type of plans.

A medicare supplemental insurance plan may be a better option for you to the fill the gaps with your Medicare Part A and Medicare Part B.

If you want to use the services of a doctor that is not in the network you will be responsible to pay the incurred cost yourself. This normally isn't a problem with large managed care companies, especially in urban city areas. For those considering buying a Medicare Advantage plan, one of the first steps is to make sure your regular doctors are in the plan's network. If not, and you want to stay with your current doctors, this may not be the plan for you.

Another problem can arise if patients want to see a specialist. If their HMO primary care physician or the HMO itself decides it isn't necessary, they'd have to pay for the visit out of their own pocket. Likewise, if the HMO decided certain care -- for example, extensive physical therapy or home healthcare -- wasn't necessary, the HMO wouldn't pay for it even if their doctor wanted to prescribe the care.