How To Choose A Medicare Advantage Plan?

How To Choose A Medicare Advantage Plan?

Medicare Advantage plan is one of the option for Medicare beneficiaries to choose and get their Medicare benefits.

Medicare Advantage plans can offer more benefits than original Medicare. Some of the Medicare Advantage plans provide prescription drug coverage, health and wellness services, and dental and vision care. There are some Medicare Advantage plan providers that are offering additional benefits for specific services or situations.

Medicare Advantage plans are divided into different categories. We will discuss about them in this page.

The 5 Types of Medicare Advantage Plans

There are 5 types of Medicare Advantage plans:

HMOs (Health Maintenance Organization)

PFFS (Private Fee-for-Service) Medicare Advantage Plans

HMO-POS (Health Maintenance Organization – Preferred Provider Organization) Medicare Advantage Plans

PDPs (Private-Delivered Medicare Advantage Plans) Medicare Advantage Plans

Local PPO Medicare Advantage Plans

HMO plans are the most affordable Medicare Advantage plans. HMOs are less costly because their members have no out-of-pocket prescription drug costs. HMOs and PFFS Medicare Advantage plans are the most popular Medicare Advantage plans.

HMOs offer preventive care like checkups, blood tests and vaccines.

But they usually require Medicare beneficiaries to use the HMO's provider network.

HMOs preventive care benefits also do not apply to services and equipment that are not medically necessary.

What does this mean?

It means that if the HMO's doctor believes that you do not need the service or equipment, you will not be able to get it.

HMOs also have deductibles and copayments. HMOs usually have additional benefits like free preventive care, free annual wellness visits and free immunizations. But PFFS plans are usually more comprehensive than HMOs and they cost more.

PFFS plans offer all the benefits of original Medicare. They also offer extra benefits like prescription drugs and dental coverage. PFFS plans provide a wide range of benefits but you will be responsible to pay for some of the costs like copayments, deductibles and coinsurance.

PFFS plans are one of the most comprehensive Medicare Advantage plans. They will cover most of your costs not covered by original Medicare benefits and they will also cover extra services.

But they also have a monthly premium. You will have to pay for your PFFS plan monthly premium even if you do not get any healthcare services.

HMO-POS plans are another type of Medicare Advantage plan option.

What's the difference between HMO and HMO-POS?

HMO-POS plans are like the HMOs but they are less restrictive and provide more choices. They do not require Medicare beneficiaries to join the HMO provider network.

HMO-POS plans are also like PFFS plans. They have copayments, deductibles and coinsurance. They also have premium. You will have to pay for your HMO-POS plan even if you do not get any healthcare services.

PDP (Private-Delivered Medicare Advantage Plans) Medicare Advantage Plans

PDP plans are another type of Medicare Advantage plans.

What's the difference between PFFS and PDP?

PDP plans are like PFFS plans. They offer all the benefits of original Medicare and also additional benefits.

PDP plans have a monthly premium but they do not have copayments and deductibles. You will pay for your PDP plan monthly premium even if you do not receive any healthcare services.

Local PPO plans are another type of Medicare Advantage plan option.

What's the difference between PPO and Local PPO?

Local PPO plans are like PPO plans but they have a lower premium.

Medicare Advantage Plans for People with Medicaid

Medicare beneficiaries who have Medicaid coverage have additional options for Medicare Advantage plans. They can enroll in the Medicare Advantage plans that are accepting Medicaid.

Medicare Advantage plans are usually less expensive than PFFS and PDP plans. But they may have a premium. Medicaid is a program for low-income people. Medicaid pays for Medicare premiums, deductibles and coinsurance.

Medicaid pays Medicare Advantage plans monthly premiums. It also pays for copayments, deductibles and coinsurance.

Medicare Advantage plans are a good option for people who are on Medicaid. They offer the same coverage as Original Medicare and also additional benefits like prescription drug coverage.

There are also Medicaid Advantage plans. Medicare beneficiaries who have Medicaid Advantage plans can enroll in Medicare Advantage plans.

Medicare Advantage Plans for People with Medicaid and Medicare

Because Medicaid pays Medicare Advantage monthly premiums, Medicare beneficiaries with Medicaid and Medicare will have to pay for Medicare Advantage plan monthly premiums.

Medicare beneficiaries with Medicaid and Medicare who have PFFS and PDP plans will have to pay for the Medicare Advantage plan monthly premiums and for Medicare Part B premium.

Medicare Advantage Plans for People with Medicare and Medicaid

People with Medicare and Medicaid can enroll in Medicare Advantage plans that are accepting Medicaid.

Medicare Advantage plans are less expensive than Original Medicare. But they have a premium. The premium is usually more than Medicare Part B premium.

Medicare Advantage plans cover all the Medicare Part A and B benefits. But they usually do not cover the Part D prescription drug costs.

Medicare Advantage plans for people with Medicare and Medicaid are a good option. They offer the same coverage as Original Medicare and they also offer additional benefits.

Medicare Advantage plans are Popular for Seniors

Medicare Advantage plans are very popular for seniors. HMOs and PFFS plans are more popular than other Medicare Advantage plans.

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