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Different Types of Medicare Advantage Plans

by Thomas Browne

You might have heard about Medicare Advantage plans and wondered if you should get one. But what exactly is a Medicare Advantage plan? And when would it be a good idea to sign up for one? A Medicare Advantage Plan is an alternative to Original Medicare and could save you money on out-of-pocket prescription drug costs. It’s offered by private companies approved by the Centers for Medicare & Medicaid Services. They cover hospital, doctor office visits, and sometimes dental care.

Unlike Original Medicare, Medicare Advantage Plans help pay for most prescription drugs, not preventive services like checkups. It can save you money because the drug companies are paying much less for those services. Under Original Medicare, if you need a preventive service like cholesterol screening, your Medicare Part B plan will pick up the entire cost through a separate network of doctors and hospitals. But under a Medicare Advantage plan, the drug company is expected to cover all services paid for by Part D.

HMO Medicare Advantage Plans

 In this plan, you must use doctors, hospitals, and pharmacies in the plan’s network. You pay a copayment for most doctor visits and hospital stays. If you go out of the network, you only pay the coinsurance amount.

PPO Medicare Advantage Plans 

In this plan, you can choose any doctor, hospital, and pharmacy, whether inside or outside the plan’s network. In addition, you have a copayment for doctor visits and hospital stays. If you go outside the network, you only pay a coinsurance amount.

Open Access Medicare Advantage Plans 

These must be available to anyone eligible for Medicare and also cover hospitalization, emergency care, preventive services, and outpatient medications in your network. In addition, you have a co-payment for services not covered by the plan and outside of the plan’s network.

Health Maintenance Organization Medicare Advantage Plans

It is a plan where the plan pays for care in a network of doctors and hospitals. But you do not need to stay in that network. Instead, you will get bills from them, like an HMO. The plan has a higher monthly premium but also provides more benefits, like wellness and preventive care services. The advantage of the HMO plan is that there is no coinsurance amount after your deductible except for uncovered services.

Special Needs Plan

This plan is for people who qualify for both Medicare and Medicaid. It is designed especially for people with chronic diseases and requires special care. They are customized to meet a specific patient’s needs and are not covered by all Medicare Advantage Plans.

Prescription Drug Plan (Part D)

It is a plan that helps pay for some or all of your prescription drugs. Usually, your doctor or other health care provider gives these directly. There is no limit on the number of prescription drug benefits you can receive. Many Medicare Advantage Plans cover prescription drugs. But it would help if you also bought a Medicare Advantage health plan or are exempt. 

Medicare Secondary Payer 

It is a Medicare Advantage Plan that covers outpatient services and some or all of your inpatient hospital stay. It’s similar to Original Medicare. But you are responsible for paying the deductible, copayments and coinsurance amount before your Medicare Part B plan pays anything. The advantages of this plan are that there is no additional cost to pay while in the hospital, no coinsurance on most outpatient services, and you have access to any area doctor you want. 

Voluntary Medicare Advantage (VA) Plans

It is for people eligible for Medicare and the Veterans Affairs (VA) health programs. They are similar to Original Medicare. But you can access VA benefits if you have a non-service-connected disability or medical condition or qualify for Social Security Disability Insurance. In addition, the VA has a network of doctors and hospitals, which can differ from what you get with your private plan.

Medigap Plan 

The Medigap plan is a Medicare Plan which covers the deductibles, coinsurance and copayments not covered by Original Medicare. It also pays for some of the services not covered by the Original Medicare plan. However, it only covers you after your yearly deductible, and your Part B coinsurance amount has been met. 

Medicare Choice Plans

In Medicare Advantage Plans, you can choose any doctor and hospital within the network. You do not need to go out of the plan’s network. But, you may have to pay out-of-pocket for preventive services like mammograms and prostate tests. The coinsurance amount is reduced to zero after your out-of-pocket costs are paid.

Special Needs Plans (SNP)

These are for people with chronic diseases requiring specialized services or significant functional limitations that restrict their ability to obtain or complete ordinary health care without assistance from another person.

Convalescent Center Option

If you choose this option, you’ll be covered for all Part A and B services in a Skilled Nursing Facility or Non-Hospital SNF after a three-day qualifying hospital stay. But you’ll be responsible for the current year deductible and partial Part B coinsurance amount. Also, it doesn’t include continuous care or custodial care. 

Home Health Care Plan

  • In this plan, you’re covered by your usual health insurance provider. But, you can get help with home health care at their discretion. 
  • Your regular Medicare Advantage plan will pick up the costs of any Part A and Part B services that help you maintain your home and be active in your daily life. 
  • The plan covers all services paid for by Medicare, except those considered urgent or emergent services not covered by Original Medicare.

Medicare Advantage Plans can give you many benefits and make your Medicare more flexible and easier to use. These plans are for all those who want the best of health care and cost-management care. Enrollment in Medicare Advantage Plans can be made on an annual or even monthly basis. Choosing between different Medicare Advantage Plans is advisable to make the most out of your health care benefits under Medicare. Therefore, it is better to find a plan that offers you the best coverage, and at the same time, it should be affordable for you.

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