Medicare Advantage Plans in 2021
Private insurance companies offer a variety of Medicare Advantage plans, and each comes with unique benefits and coverage details. Health Maintenance Organization (HMO) plans tend to be the most popular among Medicare Advantage enrollees.
Which Medicare Advantage plan is best for you depends on your personal circumstances. We recommend reaching out to an experienced Medicare insurance agent to ensure that you’re making the right decision.
What does a Medicare Advantage plan cover?
What Medicare Advantage plans are out there?
Medicare Advantage plans include a variety of benefits, and what exactly your plan will cover depends on which type of plan you enroll in. The types of Medicare Advantage plans that are available to most beneficiaries are as follows:
- Health Maintenance Organization (HMO): HMO plans require that you get your treatment from doctors within your plan’s network, with the exception of emergency care, out-of-area urgent care, and out-of-area dialysis. Though some plans allow you to visit out-of-network physicians, the cost for you will be higher.* Additionally, you typically need a referral to see a specialist.
- Preferred Provider Organization (PPO): PPO plans allow you to pay less when you visit a doctor, specialist, or hospital that is within the plan’s network. Consequently, you will pay more when you use providers outside of the plan’s network. Most PPO plans include prescription drug coverage as well.
- Private Fee-For-Service (PFFS): PFFS plans usually allow you to get your medical services from any Medicare doctor or hospital that has agreed to the plan’s payment terms. Some plans may also have networks, and in this case you can visit providers within your network to keep costs low.
- Special Needs Plans (SNP): SNPs are limited to individuals with special diseases and/or disabilities. These plans are tailored to the conditions and needs of their beneficiaries. The plans’ networks have specialists in the diseases and conditions that affect the plans’ members. SNPs also must include emergency care and Part D drug coverage. Members are required to have a primary care doctor (or care coordinator), and it is necessary to receive referrals to visit a specialist.
- Medicare Medical Savings Account (MSA): MSA plans are a unique Medicare Advantage plan setup. They combine a high deductible and a savings account from which you can withdraw funds for health care expenses. However, only Medicare-approved services will count towards your deductible. This means that you will usually have to cover some out-of-pocket costs before your plan’s coverage kicks in.
*There is a subset of HMO plans called HMO-POS. These are “point-of-service” plans that allow you to visit some out-of-network providers at a higher cost to you.
Are there other Medicare Advantage plans?
The policies listed above are the Medicare Advantage plans that are available to most people. However, there are other types of Medicare plans aside from Medicare Advantage plans that certain people can sign up for. These include Medicare Cost Plans, Programs of All-Inclusive Care for the Elderly (PACE), and demonstrations/pilot programs.
We know all of this Medicare Advantage information is a lot to process. If you’re looking for guidance when choosing an Advantage plan or enrolling in Medicare, set up a call about Medicare plan options, enrollment, and more. An experienced insurance agent here at Medicare Plans Direct can lead you in the right direction, at no extra charge to you.