Part C - Medicare Advantage (MA)
Medicare Advantage plans replaces the benefits of Original Medicare (Parts A & B) and provide coverage that must, at minimum, be equal to the benefits found Original Medicare. Many times Medicare Advantage plans include a Part D prescription drug plan. Specific information about the plans coverage can be found in the summary of benefits and Rx drug formulary sent to each enrolled beneficiary yearly.
Types of Plans
Health Maintenance Organization (HMO) – These plans are networked by the county, require referrals to see specialists, and utilize a method of treatment called step therapy. They limit the overall exposure found in Parts A and B of Original Medicare and come with a Maximum Out of Pocket.
Typical Cost is $0 but in some areas a premium may be charged. It is best to always consult with a licensed agent in your area. Information about coverage options is also provided in the back of the Medicare and You book sent out yearly by the CMS.
Preferred Provider Organization (PPO) – This plan provides a network of care at a lower cost with the ability to see doctors and specialists outside of the network at a higher cost. Selecting a Primary Care Physician (PCP) is not necessary.
The premiums and benefits of these plans will vary based on the insurance company and benefits provided.