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2021 Medicare Advantage Plans

Medicare Advantage Plans are sometimes called Medicare Part C or MA Plans. These plans are offered through private companies that follow the rules required by Medicare. These plans provide all of your Medicare Part A and B services, many offer additional benefits such as dental, vision, hearing, and prescription drug coverage.

It’s important to keep in mind that most of the time, you’ll need to choose providers that are part of the plan's network to get the lowest costs for care. Some options allow you to visit doctors that are out of the network but doing so will often come at a higher cost. These plans also have a limit on how much you’ll have to pay out-of-pocket each year.

Below, we’ll be looking at the various Medicare Advantage Plans available to help you get a better understanding of what each of these can offer.

Health Maintenance Organization

HMO plans require that you get your care from providers that are in your network in most cases. The only times that you can go out of your network is if you need out-of-area dialysis, out-of-area urgent care, or emergency care. Some of the plans will let you go out of your network for certain services but using care in your network is a more affordable option. Prescription drugs are usually covered by HMOs.

Preferred Provider Organization

PPO plans are offered through private insurance companies and will have a network of doctors, health care providers, and hospitals. With most of these plans, you can get your care from any provider even if it’s not in the network. Of course, using in-network doctors will generally mean that costs will be lower.

Prescription drugs are typically covered with these plans, but you need to be sure that you choose a PPO that provides this coverage. You don’t need to choose a primary doctor with a PPO, and most of the time you won’t need to get a referral to see a specialist.

Private Fee for Service Plans

PFFS Plans are offered by private insurance companies. This type of plan will determine how much it will pay your health care providers and hospitals and how much you will have to pay when you get care.

If you join a PFFS plan that doesn’t have a network, you can choose any doctor or hospital to provide your care. If you’re part of a PFFS that does have a network, you can see any network provider that will treat patients who have your plan. You can still choose an out-of-network provider that accepts the plan’s terms. Your costs will be lower if you choose a doctor or hospital that is in your network, though.

Special Needs Plans

Medicare SNPs limit membership to those who have specific diseases or characteristics. They typically require that you get your services and care from providers that are in your SNP network. However, there are some exceptions to this rule. If you have a medical need that requires urgent or emergency care, you don’t have to use someone in your network. Also, if you have end-stage renal disease and need out-of-area dialysis, you can use an out-of-network provider.

The SNPs are required to provide Medicare prescription drug coverage. In some cases, you may need to choose a primary doctor, and you will typically need to have a referral to see a specialist.

Medicare Medical Savings Account Plan

These plans are similar to Health Savings Account Plans available outside of Medicare. The MSA plans have two parts. The first of these parts is the Medicare Advantage Plan C, which is a high-deductible health care plan. The plan will only cover your costs after you meet your yearly deductible, which can vary.

The second part of the plan is the savings account that’s specifically for medical savings. The MSA Plan deposits money into your account, and this money can be used to pay for your health care costs before you meet the deductible.

This type of account can cover a range of options that aren’t covered by Part A or B including dental, hearing, vision, and long-term care that Medicare doesn’t cover. Keep in mind that MSA plans do not cover Part D. You’ll have to join a Medicare Prescription Drug Plan.

HMO Point of Service Plans

This type of plan has many similarities to an HMO plan. However, this plan will allow patients to use providers who are not a part of their network for some or even all of their services in some instances. For example, one of these plans might cover some types of care out of network but not others. When choosing one of these plans, it’s important to know what is and is not available out of your network.

With these plans, you’ll likely need to have a referral from your primary doctor to see a specialist. The plan has separate deductibles for in and out-of-network services.

Medicare Advantage Plans can provide you with more benefits and coverage than what you would get with Part A or Part B alone. Those who are seeking plans should be sure to check to see that they’ll have the coverage they need with the plan they choose.

Resources: https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-medical-savings-account-msa-plans https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/preferred-provider-organization-ppo https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/health-maintenance-organization-hmo

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Medicare: Things to consider

  • What are the costs?
  • What does the plan cover?
  • How does it effect other coverages?
  • Do you need to join a Medicare Prescription Drug Plan?
  • What are the Doctor and Hospital coverage options?
  • What is the quality of care?
  • Does it include travel coverage?
  • How does Medicare work?
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