Medicare Advantage

A Medicare Advantage (MA) plan is a private health insurance plan approved by Medicare. You may opt to get your Part A, B, and D benefits from a Medicare Advantage plan instead of traditional Medicare. These Medicare private insurance plans usually have an HMO or PPO network of doctors.

With Original Medicare, you will have deductibles and a 20% coinsurance on Part B. You can visit any doctor or hospital that participates in Medicare, and most do.

With an Advantage plan, you will use the plan’s network of providers, which is usually local.  You will pay co-payments when you receive healthcare services. Each plan sets its own cost-sharing. For example, you might pay a small copay for a primary care doctor visit and perhaps a higher copay to see a specialist. Likewise, some plans will charge you a daily hospital copay, and other plans might charge a flat amount for the whole stay.

Medicare Advantage plans include HMO, PPO, SNP, PFFS, and MSA. These plans and plan types come with a ton of information. Medicare Advantage Plans are private insurance plans that help with gaps in Medicare coverage. Although they sound like Medigap plans, don’t confuse the two as they have some notable differences.

You are eligible for a Medicare Advantage plan if you have Original Medicare (Part A and Part B). Even those on Medicare under 65 due to disability may enroll. You may sign up for a Medicare Advantage policy if you live in your chosen plan’s service area.

When you enroll in a Medicare Advantage plan, you will pay your chosen plan’s monthly premium in addition to your Medicare Part B premium.

Low-income or Medicaid-eligible beneficiaries may qualify for extra help paying for premiums, deductibles, and copayments. Extra Help qualification is based on your annual income and can change anytime.

Medicare supplements pay as a secondary insurance to Medicare Part A and Part B. This means they pay after Medicare first pays its portion of the bill. You stay enrolled in Original Medicare, and Medicare sends the remainder of your bills to your supplemental company. Then the supplement company pays its share according to which plan you are enrolled in. Each Medigap plan provides different benefits and the top three most popular plans are Plan F, Plan G, and Plan N.

Medicare Advantage plans, on the other hand, are entirely separate from Medicare. When you enroll into a Medicare Advantage policy, you get your benefits from the plan, not Medicare. You agree to use the plan’s network of providers except when you need emergency care. You’ll pay copayments for your health care treatment as you go along. Think of these plans as an alternative to Original Medicare.