Medicare Advantage

Medicare Advantage

Medicare Advantage (Part C) is an all-in-one Original Medicare alternative that coordinates your healthcare benefits to lower costs.

You can enroll in an Advantage plan as long as you’re enrolled in Medicare Parts A and B first—you cannot be turned down based on your health or finances (with the exception of Special Needs Plans). The choice between Part C and Original Medicare, then, is completely up to you.

The Advantage Plans

Within the category of Medicare Advantage, there are five different types of plans:

  • Special Needs Plans (SNPs)
  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private-Fee-for-Service (PFFS) Plans
  • Medicare Medical Savings Account (MSA) Plans

Each of these plans functions in the same way, but with a few key variations in price and specific structure.

To enroll in a Special Needs Plan (SNP), you must either be in great financial need or have a serious health condition. If you are enrolled in both Medicare and Medicaid, you are eligible for a D-SNP. If you have a qualifying illness/condition, you are eligible for a C-SNP. If you live in an institution, such as a nursing home, you qualify for an I-SNP.

Of the Advantage plans, Health Maintenance Organization (HMO) plans rely the most on its network. Out-of-network emergency care is covered, but any other care outside of its specified limits will not be covered. And, you are required to have a primary care physician and specialist referrals.

Preferred Provider Organization (PPO) plans, on the other hand, do not require a primary care physician or referrals. Their networks cover a large area, with opportunities to seek healthcare from a variety of providers.

With Private-Fee-for-Service (PFFS) plans, the network of coverage is negotiable. Your insurance provider has a healthcare network of people who have agreed to accept its plan. However, you have the opportunity to negotiate and receive coverage from any other providers that agree to the terms. These plans will determine how much they will pay for your medical services and how much you will pay.

Medicare Medical Savings Account (MSA) Plans combine a bank account and high deductible. The high deductible must first be met in order for the plan to provide coverage. The plan will also deposit money into the bank account, which you can use to pay toward your deductible.

Part C vs. Original Medicare

Medicare Advantage is an upgraded version of Original Medicare. No matter the insurance provider or Advantage plan you choose, it is required by law to cover all of the same benefits as Original Medicare.

Your out-of-pocket costs compared to an Original Medicare plan, then, will always be lower with an Advantage plan. Most providers offer little to no monthly premiums, meaning that you won’t be paying much for this additional cost coverage, either.

Because it is inexpensive and provides a better alternative, Part C will likely be a better option for you than Original Medicare on its own.

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Need Help Finding an Advantage Plan? Call Texas Medicare Advisors

Choosing an Advantage plan is one of the most important decisions you will make as a Medicare beneficiary. But how do you compare your options? How do you know if it’s the best option for you?

Texas Medicare Advisors has the skills and experience to get you the coverage you need. We will make sure that you’re getting the best coverage in your area. If you want to get started, give us a call at 512-900-3008.