Call Us:719-360-2795
Home » Medicare Advantage Programs
April 22, 2016

Medicare Advantage Programs

Medicare Advantage Programs

Medicare Advantage Programs or Medicare Part C is one of Medicare’s supplement programs to compensate for additional needs of those insured under this medical plan.

What is Medicare Part C all about? It combines the benefits that the insured can derive from both plans A and B of Medicare in cooperation with private insurance companies. This excludes hospice care. These are through PPO, HMO (also known as Private Fee For Service) healthcare plans.

Under this plan, those that are being provided under plan D (prescription drug coverage) are also covered in Medicare Advantage plan.

Here are the differences this program can make in other healthcare programs:

1. HMO(health maintenance organizations) Plans

* In most cases, you are required to select primary care doctor

* Referral is important under the said coverage and must be made by your primary physician to enable you to seek medical treatment from a specialist

* The premium also covers prescription drugs, whether generic or branded medicines

* Your health or treatment can only be given by the medical practitioners included in your HMO’s network

2. PPO (preferred provider organizations) Plans

* Generic or branded prescription drugs are covered by the monthly premiums.

* No referral by your primary doctor is required for you to see a specialist

* You are not required to choose a primary care doctor.

* You can choose your own physician or hospital even at higher cost.

3. PFFS (Private Fee For Service) Plans

* In most cases you are required to enroll in a Medicare Prescription Drug Plan to qualify for coverage that includes prescription drugs

* You can go to your preferred doctor or any hospital so long as it is accredited by Medicare. The said medical practitioner or hospital must be willing to accept PFFS plans

* There is no need for your to choose a primary care doctor to qualify under this program

* No need to be referred by your doctor to turn to a specialist for further check-ups

Do these plans cover additional health care benefits?

Yes, there are Medical Advantage Programs that will include

* dental,

* gym memberships

* hearing,

* vision,

* Other health and wellness programs.

What does a Medicare Advantage Plan Cost?

Be aware that these programs receive a fixed amount to provide for your medical care. This is provided by CMS (Centers for Medicare& Medicaid Services). The costs that are being paid for your lab tests, medical services, and doctor’s fees are covered by CMS. The costs may include co-insurance and co-pays, monthly premiums and yearly deductible for prescribed drugs.

How and when can one join in an Advantage plan?

These individuals are eligible under this program if they are:

* Covered by both Part A and Part B of Medicare

* Reside in an where a plan is available

Unfortunately not all states provide this type of medical plan so make sure that you search online to see if your state allows for this type of coverage. Medical Advantage Programs can really help in the reduction of your medical fees, but you must also see if this is the right coverage for you.


An article by Sean Goudeloc

Published at:

Leave a Reply

Your email address will not be published. Required fields are marked *