Medicare Advantage (MA)

Medicare Advantage plans, also referred to as “MA” or “Part C”, are Medicare health plans offered by private insurance companies that combine all of your Part A and Part B benefits. Some plans may have prescription drug coverage as well (MAPD). The most common forms of Medicare Advantage plans are the following:

  •        Health Maintenance Organization (HMO)

  •        Preferred Provider Organization (PPO)

  •        Private Fee for Service Organization (PFFS)

The two most popular types of MA plans are HMO’s and PPO’s. When enrolled in an HMO plan, you must choose a primary care doctor and you can only see other doctors that are within the same network as your primary care doctor. You must also get authorization from your primary doctor to see a specialist.

PPO plans offer more flexibility and freedom than an HMO plan but still have a lot more restrictions and less benefits then a Medigap plan. PFFS plans are less common and you must find out ahead of time if the facility you want to go to accepts the particular PFFS plan that you have.

Medicare Supplement Plans (Medigap)

Medicare supplement plans, or Medigap plans, are Medicare health plans offered by private insurance companies. A Medigap plan is meant to pay what Part A and Part B of Medicare plans do not cover in full. There are 10 standardized Medigap plans and they are offered in every state except Massachusetts, Wisconsin and Minnesota. The ten plans range from Plan A to Plan N. Each plan is different and offers a unique combination of coverage and deductibles. Because the plans are standardized, any given plan (e.g. Plan F) will have the same exact benefits regardless what company is offering the plan. The only difference is the price you pay in premium. When comparing plans, make sure you compare the premium cost for the same plan from company to company

Summary:

Medicare Advantage Plans

  • Can only see doctors and hospitals that accept the specific plan you have

  • Copays and deductibles 

  • Sometimes offer Dental, Vision, Hearing Benefits

Medicare Supplement Plans (Medigap)

  • Ability to go to any doctor or hospital in the country that accepts Medicare without a referral

  • Minimal to no out-of-pocket cost

  • More comprehensive coverage

  • Foreign travel benefit

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