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Medicare Advantage – Part C

Medicare Advantage Plans

Medicare Advantage plans are a popular low cost alternative to Medigap coverage. These insurance policies are offered by private insurance companies with a contract from Medicare. Advantage plans will usually have a low or $0 premium in addition to your regular Part B premium. This type of plan may include Part D prescription drug coverage although health coverage only is also available.

There are many types of Medicare Advantage plans available and you should check to see which plans are offered in your county. We have included some brief descriptions and helpful tips to provide you with a better understanding. You may also contact us to speak a live representative who will answer any specific questions that you may have.

Medicare Health Maintenance Organization (HMO)

Health Maintenance Organization members are required to choose a primary care physician within the plans network. In order to see a specialist you will need to get a referral from your primary care doctor. The specialist must also be in the plans network. You must also use network providers for all other services including hospitals, lab work, and durable medical equipment suppliers. HMO plans usually offer the lowest premiums and copayments. This is a good choice if your Doctors and health providers are a part of the plan network.

HMO Point Of Service (POS)

A Point of Service (POS) plan is a type of managed health care system that combines characteristics of the HMO and the PPO. Like an HMO you pay only a minimal co-payment when you use a health care provider within your network. You also must choose a primary care physician. If you choose to go outside the network for health care, POS coverage functions similar to a PPO.

The plan will specify which benefits are available under the POS option and how much the co-payment will be for out-of-network benefit.

Medicare Preferred Provider Organization (PPO)

Preferred Provider plan members have more freedom of choice. A PPO also has a network of providers but you are free to use out of network providers if you wish. You will simply pay a slightly higher co-payment when using out of network Doctors and health care providers. These plans offer local, regional or Nationwide coverage. A good choice for those who travel or simply wish to have greater flexibility.

Private Fee For Service (PFFS)

Private Fee For Service plans do not have a network. You can use this plan at any Doctor or provider who agrees to the terms and conditions of payment from the plan. These plans include Nationwide coverage and are a good option for those who travel or live in a rural area. PFFS plans are only offered in select Counties.

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