Medicare Advantage Plans


Medicare Advantage Plans

When determining the best healthcare insurance for you and your loved ones, it’s important to be informed of all of your options and what they offer. In this post, we’ll explore what Medicare Advantage Plans are, what their different types cover and how to get in touch with Western Washington Medical Group (WWMG) should you have questions about your coverage plan.

What are Medicare Advantage Plans?

Medicare Advantage Plans are an all-in-one alternative to Original Medicare Plans. Often called “Plan C,” they are offered by private vs. public companies and officially approved by Medicare. It’s basically a bundle vs. an essential coverage plan.

In addition to ‘extras’ such as coverage for dental work and hearing, Medicare Advantage Plans sometimes also include perks such as gym memberships and transportation for doctor’s visits.

When you’re searching for a plan, you should consider asking the following questions:

  • Does the plan offer extra benefits that Original Medicare doesn’t cover, such as vision, dental, prescription drugs, etc.?
  • What costs will I incur for supplies and services?
  • Does the plan have a provider network for some or all services offered?

Types of Medicare Advantage Plans

Every Medicare Advantage plan comes with the rights and protections of Original Medicare and you can only join at certain times of the year. In addition, pre-existing conditions will not disqualify you from getting a plan nor will you need Medigap. Plus, certain clinical research studies may be covered under Medicare Advantage Plans and your out-of-pocket costs may be lower than Original Medicare.

The duration of a Plan commitment is usually one year. Because there are a variety of plans available that fall into the Medicare Advantage category, it’s best to read up on each to determine what’s right for your medical needs.

Health Maintenance Organization (HMO) Plans

This plan is designed for those covered to use in-network providers for all functions except for out-of-area urgent care, out-of-area dialysis and emergency care. There are additional exceptions with certain plans for out-of-network care, but it will generally be at a higher cost to the patient.

In addition, HMO plans typically require the user to choose a primary care doctor and get referrals to specialists for additional care from that doctor. In most cases, Medicare drug coverage (referred to as Part D) will be included and cover the cost or a portion of the cost for prescription drugs.

Preferred Provider Organization (PPO) Plans

This type of Medicare Advantage Plan is offered by a private insurance company. A PPO Plan affords the patient the freedom to choose their care providers but may come at an increased cost.

There is no need to choose a primary care doctor on this plan and usually prescription drugs are covered. You may also be able to save additional costs by using preferred providers.

Private Fee-for-Service (PFFS) Plans

 This type of plan also allows the patient the freedom to be treated by an in-network or out-of-network provider, though there may be an increased cost for those out-of-network. They also don’t require that you determine a primary care provider or a referral to see specialists.

When you are seeking treatment, you’ll need to show your ID card and verify that the provider agrees to treat you under the plan. You should only need to pay a co-payment or coinsurance amount at the time of your appointment.

Special Needs (SNPs) Plans

These plans are unique to those who have specific diseases or medical needs and live in certain institutions (like nursing homes). Applicants can also be those who are eligible for both Medicare and Medicaid. Once enrolled, the plan is then tailored to the patient’s needs to maximize results for their care.

Patients must only see in-network providers with the exception of emergency, urgent care or out of area dialysis for End-stage Renal Disease. Prescription drugs are always covered under this plan and most services require referrals with the exception of mammograms and preventative care for women.

Medicare 101 Webinars

If you have already signed up for a Medicare Advantage Plan or are trying to determine the best option for your needs, sign up for a Medicare 101 webinar today.