Medicare Advantage Plan
A Medicare Advantage Plan, also known as Medicare Part C, is a type of health insurance plan offered by private companies that contract with Medicare to provide all Part A and Part B benefits. These plans often include additional benefits such as vision, dental, and hearing coverage, and may also offer prescription drug coverage (Part D).
Medicare Advantage Plans typically operate within a network of doctors and hospitals, and beneficiaries usually need to use these providers to receive full benefits. Some plans may require referrals to see specialists. The cost structure often includes premiums, deductibles, and co-pays that vary by plan.
Examples of Medicare Advantage Plans include:
- Health Maintenance Organizations (HMOs): Require members to use network providers and get referrals for specialists.
- Preferred Provider Organizations (PPOs): Allow members to see any provider but offer lower costs for using network providers.
- Private Fee-for-Service Plans (PFFS): Allow members to see any Medicare-approved provider who accepts the plan’s payment terms.
Case Example:
- A 65-year-old Beneficiary chooses a Medicare Advantage HMO that has a premium of $30 per month, covers routine eye exams, and includes a $10 co-pay for primary care visits.
- A retiree enrolls in a Medicare Advantage PPO, allowing them to see specialists without a referral, paying a $20 co-pay for in-network services and a $40 co-pay for out-of-network services.