Medicare Advantage Plans
Medicare Advantage plans are private health plans that generally provide all the coverage of Original Medicare and more. Many Medicare Advantage plans offer lower copayments and cover benefits and services such as vision and dental not covered by Original Medicare.
Some plans may also include Part D, or prescription drug coverage. These plans are referred to as Medicare Advantage with Prescription Drug coverage (MAPD).
How do they work?
Coverage under a Medicare Advantage plan replaces your Original Medicare coverage. Some members pay $0 monthly plan premium for a Medicare Advantage plan. With low to no premiums, your out-of-pocket costs (like those paid to see a doctor or to be admitted to the hospital) under Medicare Advantage plans may be lower than your expenses would be with traditional Medicare programs.
Medicare Advantage Plan Types
Medicare HMO plans
A Medicare Health Maintenance Organization (HMO) plan covers care you receive through a network of local doctors and hospitals that coordinate your care. In most cases, if you obtain routine care from out-of-network providers, neither Medicare nor the Medicare Advantage HMO plan will pay for the costs. Your doctor may already participate in this type of plan.
Medicare POS Plans
Point-of-Service (POS) plans are HMO plans that allow the use of non-plan or non-preferred providers, but their services may cost you more.
Medicare PPO plans
Medicare Preferred Provider Organization, or PPO, plans allow you to choose between in-network and out-of-network providers. These plans provide reimbursement for all covered benefits, whether they are received in-network or not, as long as they are medically necessary. For services received outside the network, you will generally have higher copayment and coinsurance costs.
Medicare Private Fee-For-Service (PFFS) plans
Offered by private insurance companies, Medicare PFFS plans give you the freedom to receive care from the doctors and hospitals of your choice, as long as they agree to accept the plan’s terms and conditions of payment. Keep in mind that your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies.
Medicare Part D Prescription Drug Plans
Medicare Part D plans are offered by private companies to help cover prescription drugs. Everyone with Medicare can get this optional coverage to help lower their prescription drug costs. Medicare Part D covers both brand-name and generic prescription drugs at participating pharmacies.
There are two types of Medicare Part D coverages:
  • Stand-alone plans, also referred to as Prescription Drug Plans (or PDP plans), only offer prescription drug coverage.
  • Medicare Advantage plus Prescription Drug (or MAPD) plans offer prescription drug coverage as well as medical coverage for doctor visits and hospital expenses.

  • Each Part D plan has a formulary (drug list) – a list of government-approved medications the plan will cover. This list may also be referred to as a prescription drug list (PDL) or a covered medications list (CML). Drug coverage varies from one plan to another, so if you are considering a Part D plan, you may wish to review the plan’s Prescription Drug List to be sure it will meet your needs.
    How does Medicare Part D work?
    • Like other types of insurance, Part D plans may have a monthly plan premium and a yearly deductible. These vary from plan to plan.
    • You pay a portion of your drug costs, including a copayment or coinsurance. Costs vary depending on which drug plan you choose.
    • Coverage options, including drug coverage, may vary from plan to plan.
    **If you do not take prescription drugs at this time, but are eligible to enroll in Part D, you may want to consider being covered now. If you select a plan that does not cover prescription drugs and you do not have another qualifying prescription coverage you will pay a penalty in the future should you decide to enroll in a Part D plan later.
Medicare Supplement Plans (Medigap)
Benefits offered in all the Medicare supplement policies have been standardized so they can be easily compared between insurance carriers. Eleven plans are available identified as Medigap Plans A through M (except in MA, MN and WI) and carriers choose which plans they’ll offer. Every insurance company must make Plan A available.
The following chart provides a checklist of benefits by each plan so you can compare (not all plans may be available in your state). All plans include these basic benefits:
  • Medicare Part A hospital coinsurance
  • Medicare Part A extended hospital coverage (365 days after Medicare benefits end)
  • Medicare Part A hospice outpatient prescription drug copayment and inpatient respite care coinsurance
  • Medicare Part B coinsurance*
  • Medicare Parts A and B first three pints of blood
* Plan N requires up to a $20 copayment for an office visit and up to a $50 copayment for an emergency room visit
** There is also a high-deductible Plan F

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