Medicare Advantage Plan

What does Medicare Advantage Plan mean?

A Medicare Advantage Plan is Part C of Medicare and is an alternative choice to Original Medicare Parts A & B.  It is a bundle of coverage offered by private companies, and has very specific uses and qualifications. A Medicare Advantage Plan is a combination of parts A, B, and generally, part D. Part A covers Hospitalization, Part B covers Doctors Office care, and Part D is for Prescription Drugs. Medicare Advantage plans are provided by private insurance carriers. These plans are an agreement between the specific carrier and the customer. The federal government pays the insurance carrier a flat fee and allows the private insurance carrier to coordinate the individual’s medical coverage.

How do I get a Medicare Advantage Plan?

In order to qualify for this bundle, you must be eligible for part A, part B, and be current with your Part B premiums. The nature of a Medicare Advantage Plan is that of an HMO, or Health Management Organization. These two terms are synonymous with each other.  The HMO helps guide, direct and coordinate medical coverage through a primary care physician. That primary care physician will coordinate all primary care needs and issue referrals to a specialist as required.

Specific features

The HMO’s/Medicare Advantage Plans are usually area restricted. This means there are specific doctors, locations, and facilities where you can receive health care services. If you go outside of these pre-determined areas, you will generally pay at least a higher rate. In most cases, your coverage will not be extended outside that specified geographical area. An HMO plan generally does not travel very well. This means that once you get outside your geographical area, you will pay more out-of-pocket costs. The only possible exception is in emergency situations.

Big no-no’s

You cannot have more than one Medicare Advantage Plan at any given time or have a plan and an independent prescription drug plan. Having both plans will cancel each other out and you will be sent back to the original Medicare Parts A & B.

A Medicare Advantage Plan is not as complex as it seems to be. Find out everything you need to know and see which plan is right for you.

Since insurance is often times overwhelmingly confusing, we want to shed light on this industry by answering YOUR questions.  If you have any questions or concerns, comment below and your question may be the topic of our next video! 

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