Medicare Advantage Plans
What is Medicare Advantage?
Medicare Supplement (Medigap) plans cover the gaps in Medicare to cover expenses such as provider bills.
Medicare Advantage Eligibility
If you are eligible for Medicare, you are also eligible for an Advantage plan. A Medicare Advantage plan is a private Medicare insurance plan, which is an alternative way to get your Part A and Part B benefits. When you do, Medicare pays the plan a fee every month to administer your Part A and B benefits. You must be enrolled in both Medicare Part A and B before you can purchase a Medicare Advantage plan. And you cannot drop Part B. If you drop Part B, you will automatically lose your Advantage plan.
KEY POINTS:
- Enrolling in an Advantage plan (Medicare Part C), allows you to receive your Medicare benefits through that private plan instead of through Original Medicare.
- Advantage plans operate within network areas. Depending upon the type of Advantage plan you choose, they be more strict or more lenient.
- Enrollment in an Advantage plan varies throughout the year, including Initial Enrollment period, the Annual Election period, and more.
Medicare ADVANTAGE NETWORKS
| HMO | LOCAL PPO | REGIONAL PPO | PFFS | |
|---|---|---|---|---|
| NETWORK SIZE | 1 or More Counties | 1 or More Counties | Larger network area, such as statewide | Varies |
| PLAN AVAILABILITY | Most common MA plan | Most common PPO plan | Least common PPO plan | Only available in areas with less than 2 MA plans |
| SPECIFIED PCP | Yes | Usually No | Usually No | Usually No |
| REFERRALS REQUIRED | Usually Yes | No | No | No |
| MAXIMUM OUT-OF-POCKET | Yes, in-network only (no out-of-network benefits) | Yes in-network and out-of-network benefits | Yes, in-network and out-of-network benefits | Yes, in network / out-of-network benefits |
MEDICAL PROVIDER BILLS PAID
Your selected doctor bills Medicare for all services or procedures provided.
MEDICARE PAYS
Medicare is billed and pays 80% of your approved medical expenses.
MEDICARE SUPPLEMENT PAYS
Medicare Supplement plan picks up the costs exceeding the 80% covered by Medicare.
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