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What are Medicare Advantage Plans and their Types?

September 5, 2022 by bob

There are two ways to get your Medicare benefits – either by taking original Medicare plans Part A and Part B or via Medicare Advantage Plan as a federal health insurance program in the United States. In an original Medicare plan, the government pays for your Medicare benefits when you get them while the Medicare Advantage Plan is offered by Medicare-approved private insurance companies to cover your Medicare benefits. Medicare Advantage Plan is also termed as Part C or MA Plan that is an alternative way to get Medicare Part A and Part B coverage.  

The beneficiary who joins a Medicare Advantage Plan receives all the original Medicare coverage of Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) along with additional benefits such as coverage for dental, vision, hearing, and other health care. Some insurance companies also include Part D (Prescription Drug) coverage in their Medical Advantage Plans for better serving their clients. In original Medicare coverage, the beneficiary pays a monthly premium to the federal government while in a MA plan he/she pays a monthly premium to a private insurance company to receive the Medicare benefits. These private companies follow the rules and regulations set by Medicare for health insurance programs.

There are different types of Medicare Advantage Plans available through private insurance companies that work in different ways to avail of the Medicare benefits.

Health Maintenance Organization (HMO) plans:  You can only go to doctors, hospitals, or other health care service providers that are listed in the plan’s network to get the Medicare benefits.

Preferred Provider Organization (PPO) plans: You pay less for the healthcare services you receive when you use healthcare providers who participate in the plan’s network.

Private Fee-for-Service (PFFS) plans: These MA plans are very similar to Original Medicare Part A and Part B in that you can go to any doctor or hospital that accepts the plan’s payment terms. The plan clearly divides how much your insurance company will pay and how much you will pay after getting care services.

Special Needs Plans (SNPs): This MA plan provides coverage to a specific group of people with certain chronic medical conditions for specialized health care services.

HMO Point-of-Service (HMOPOS) plans: These are HMO plans that give some relaxation to the beneficiary so that he/she can go to doctors or hospitals out of the plan’s network for a higher copayment or coinsurance.

Each Medicare Advantage Plan has a different set of rules such as in some cases you may also need a referral from your primary care doctor to see a specialist. Medicare changes or updates these rules each year to ensure proper health insurance programs in the states.

Who can join a Medicare Advantage Plan?

Anyone can enroll in Medicare Advantage Plan who are eligible for or already have original Medicare coverage Part A (hospital insurance) and Part B (medical insurance). Also, you can join a MA plan only if you live in the service area of that plan to cover your Medicare benefits.

As we have already mentioned that Medicare Advantage Plans are offered by private insurance companies as per the Medicare rules. If you are looking for Medicare Advantage Plan to cover your health care, you can connect with our qualified Medicare Agent in Texas at Insurance Connection USA for the most benefits. We are a Medicare-approved insurance company and offer different Medicare plans to our clients for health insurance benefits in different forms as per the Medicare rules.

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