The Ins and Outs of Medicare Advantage Plans


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While there are reportedly 44 million people enrolled in Medicare, it’s easy to get overwhelmed by the fine print of signing up yourself. On top of that, there isn’t a one-size-fits all plan. With four main plans (Parts A-D), Medicare is a comprehensive national health insurance program that requires effort to understand.


To help you better understand the ins and outs of Part C, also known as Medicare Advantage plans, please consider the following points:

Medicare Part C

Medicare Advantage plans are an “all in one” alternative to Original Medicare. If you qualify for Medicare, you qualify for a Medicare Advantage plan. If you decide to enroll in a Medicare Advantage plan, which you might also see referred to as Part C or a MA plan, don’t worry—you will still have Medicare, as long as you are over the age of 65. Basically, Medicare Advantage plans are offered by private insurance companies that have been approved by Medicare. They include Medicare Part A, Medicare Part B and usually Medicare prescription drug coverage, also known as Part D.

Additional Coverage

One of the reasons Medicare Advantage plans are appealing to many older adults is that they tend to cover other costs that Medicare does not; this includes vision tests, hearing aids, gym memberships, and dental care.

Does it Cost a Lot to Get This Plan?

This is where shopping around is a good idea. While Medicare will pay a fixed amount for your care to the different companies that offer Medicare Advantage plans, each plan can then charge you different out-of-pocket amounts. For instance, if you need to obtain a referral first before seeing a specialist, that might impact the cost you pay, and if you go to a physician or hospital that is out of the network, that could also be more expensive. Since 2011, federal regulation has required all Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B, according to the Kaiser Family Foundation. This amount is not supposed to exceed $6,700 (in-network) or $10,000 (in-network and out-of-network combined). These amounts may increase in 2021.

Not All Plans are the Same

While Medicare Advantage plans all tend to cover things that regular Medicare does not, it is important to know that the actual types of plans vary. For instance, with a Health Maintenance Organization (HMO) plan, you will be seen by in-network doctors and facilities. There is also a Preferred Provider Organization option (PPO), which charges different amounts for physicians and hospitals depending on whether or not they are in your network. If you see someone who is not in the network, you will pay more. Another type of Medicare Advantage plan is the Private Fee-for-Service (PFFS), which lets you see pretty much any provider you wish, as long as they will accept the payment terms of your PFFS plan. A Special Needs Plan (SNP) is available to select groups of people who have a chronic health condition that requires ongoing care, and the Medicare Medical Savings Account (MSA) is an option that includes a medical savings account that Medicare deposits money into, along with a health plan with a pretty high deductible.

Which One is Best? It is Up to You

Now that you have a basic understanding of what Medicare Advantage plans cover and the different types of plans, it’s time to start comparing Medicare Advantage plans to decide which option is best for you. features a helpful chart that lays out in an easy-to-read fashion some of the differences between the Medicare Advantage HMO, PPO and other types of plans. The information details what types of providers you can see under each plan, if your out-of-pocket costs will be high or low and additional tips that will let you know if each plan is right for you.

Medicare Advantage Plans are a Solid Option

At first blush, Medicare Advantage plans can seem confusing and even overwhelming. But when you keep in mind that it’s basically a type of bundled plan that covers things regular Medicare will not, and then that there are several different types of MA plans, the process is hopefully not as confusing, and you will be able to now select the best option for your needs as you enter into retirement.

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