Medicare Advantage Plans

Often called Medicare Part C, Medicare Advantage provides beneficiaries with an alternative to obtain Medicare benefits. Those who decide to go this route will need to reach out to private insurance companies who have partnered with the Medicare agency to receive coverage. It is a requirement to already have Medicare Part A and Part B in order to obtain Medicare Advantage. 

One of the biggest upsides to Medicare Advantage, when compared to Original Medicare is that private insurers have additional options for routine services. These additional coverages can include things such as hearing aids, vision care, fitness club memberships, vision care, and prescription drugs. Many of these plans will also be more cost-effective than paying for Medicare Part A and Part B. After signing up for Medicare Advantage you will have the choice of going with a PPO or HMO plan.

Medicare Advantage PPO

Medicare Advantage PPO, preferred provider organization, plans are private alternatives to anyone who is considering Medicare as an insurance option. The plan utilizes a network of healthcare providers to obtain generally lower copays for its beneficiaries. Because you would be part of a network you normally don’t need to get referrals to see a specialist or choose a primary care provider either.

The Medicare Advantage PPO program will still give you the same benefits as you would have under Original Medicare while opening the door for other coverage options. For example, with PPO, there is a cap that is put on the out-of-pocket maximum to help protect against catastrophic spending throughout the year. In 2020, this maximum was set at $6,700 for the year. Premiums are also much lower, with some insurers offering it at a rate of $0 for coverage.

Flexibility is one of the main benefits of choosing a Medicare PPO plan. Not only does it offer cheaper costs to use in-network medical providers, but you can also go out-of-network for services at a slightly higher price. Typically, when choosing a PPO, you will also be given the option to include Medicare Part D for prescription drugs. Vision, hearing, and dental care are all options under the Medicare Advantage plan too.

Medicare Advantage HMO

The second option under Medicare Advantage is the HMO plan, or Health Maintenance Organization plan. Oftentimes, this type of program is a managed care plan that will give you access to a specific network of hospitals and doctors you can use in your local area. Care is normally coordinated by a primary care physician that you select. In the instance that you need further medical attention from a specialist, you must first get a referral from your primary care doctor.

Once a part of the HMO plan you must seek medical services from providers within your network unless it is an emergency and you are away from your normal service area. There is a second option you can select known as an HMO-POS plan that will combine benefits from both HMO and PPO plans. 

The costs of the HMO are similar to the PPO in that they tend to be lower than traditional Medicare. It will also give you access to Medicare Part D and cover options for vision, hearing, and dental care. Most network providers will also cover normal routine care for yearly exams, cleanings, fillings, and costs associated with seeing and hearing aids.

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