Medicare is a government run program that provides health insurance for the disabled and low-income families. Medicare is a somewhat complex system that can offer a variety of benefits, some of which are optional. One aspect of Medicare is the Medicare Advantage Plan, which is a partnership between Medicare and certain private insurance companies.
Identification
Medicare Advantage programs are health plans that are offered by private companies and are approved by Medicare. These plans are also called "Part C" or MA plans. If you opt for a MA plan, Medicare will pay a certain amount of money to these companies for your health plan. These health plans cover the typical Medicare health benefits and usually include Medicare prescription coverage as well.
Types
Medicare Advantage plans can take a variety of forms. One type is called a Preferred Provider Organization (PPO), in which patients are allowed to visit any physician who is part of the organization's network. Another common type is the Health Maintenance Organization (HMO), which requires all patients to see their primary care physician before going to a specialist. Others include private fee-for-service plans, in which patients can go to any physician, but pay a premium for the visit, as well as medical savings account plans, in which patients are given a set amount of money in an account to use however they wish for health care costs.
Differences
Medicare Advantage plans are required to provide the same basic coverage as standard Medicare. This means that people on a Medicare Advantage plan will still receive the same healthcare and prescription coverage as they would if they were not using a Part C plan. There are two ways in which these plans can differ from standard Medicare. The first way is that these plans may have different co-pays or deductibles than Medicare--usually these fees are lower with Medicare Advantage; although, there is usually an additional monthly premium. They may also include additional benefits for things such as vision and dental coverage. On the other hand, with Part C plans, patients are usually more restricted in terms of which doctors they can see as compared to standard Medicare.
Eligibility
In general, anyone who has both Part A and Part B coverage from Medicare can join a Medicare Advantage program. This includes patients who have a pre-existing medical condition--with the exception of patients with end-stage renal disease (permanent kidney failure requiring dialysis treatments). Also, in order to have a Medicare Advantage plan, the patient must live in an area where such plans are offered. Although all states have Medicare Advantage coverage, the actual plans that are available may vary from state-to-state.
Other Factors
In some cases, moving to a Medicare Advantage plan can cause people to lose their insurance coverage from a union or employer, so it is important to talk with a representative from your insurance company before switching plans. Also, switching to a Medicare Advantage plan can cause people to lose their Medigap insurance (a supplemental Medicare insurance plan). In general, people can only join Medicare Advantage plans during specific portions of the year (November 15 to December 31).
Differences In Plans
The benefits that each plan offers vary. For example, with a PPO plan, prescription drugs are usually covered, but you are required to stay within a network of providers (unless you wish to pay more). With an HMO, prescription drugs are usually covered and you will need to select a primary care physician (PCP), whom you must see for a referral for all procedures done by a specialist. With a private fee-for-service plan, you may have prescription coverage and can see any physician, but he may decline to treat you because of the variabilities in how much the plan pays per service. With a Medical Savings Account (MSA), your prescription medications will generally not be covered and you may see any doctor you wish. After you have paid your deductible in an MSA, all medical expenses will be covered by your plan's "bank account" until you have used the balance of your account.
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