Why Choose Medicare Advantage?
Medicare Advantage (MA), also referred to as Part C, is a way to get health coverage if you are eligible for Medicare. Rather than enroll in Part A and Part B—which is administered by the federal government—you can purchase an MA plan from a private health insurance company on the open market.
The benefits covered by Part C are the same as Part A and B. This means you get the same coverage for office visits, preventive care, and hospital services as if you had the original coverage. But some people choose MA Plans because they often include extra coverage and features such as dental, vision, or fitness and wellness programs. Read more about Part C added coverage.
Most of these plans have no deductibles and many have zero premiums, but some may include these additional costs. The coverage options and associated costs vary from plan to plan and availability depends on where you live.
Parts A and B don’t include coverage for prescription drugs. If you choose to enroll in this traditional coverage, you have the option to enroll in a Part D Plan for medications. MA Plans often package in Part D coverage for prescription drugs, meaning you have access to health care and medications under the same plan.
Doctors and Provider Access
Because these plans are offered by private insurance companies, they operate similarly to employer-based health insurance plans in terms of access to doctors and providers. The two most common types of MA Plans are HMO and PPO.
HMO (Health Maintenance Organization) Plans
This plan requires you to use only doctors, specialists, hospitals, and other providers that participate with the HMO network. You may also need a referral from your primary care physician to see a specialist.
The insurance company plan contracts with providers who agree to accept the MA Plan’s fees for services. If you choose to go outside of the network for care—except for urgent care, emergencies, and some other situations—the services may be denied and you’ll have to pay out of pocket. Learn more about what is covered and what isn’t here.
PPO (Preferred Provider Organization) Plans
These plans use a contracted network of doctors and providers like HMO plans, but they include the option to go outside the network—but you’ll pay more out of pocket. These plans do not require referrals to see a specialist or require you to choose a primary care physician to coordinate your care.
Whether you choose an HMO or PPO Plan, it’s important to check the insurance company’s network before purchasing a plan. If you are currently seeing a doctor or specialist, you may have to switch providers if they are not included in the network.
How Much Do MA Plans Cost
The cost comprises three major areas. If you enroll in an Advantage plan, your first cost is your Part B premium, which is deducted from your Social Security benefit. This amount varies depending on income but is about $121 for most people. Some Advantage plans may help pay for your Part B premium, so it’s important to shop around.
Second, you may pay an additional premium to the insurance company. These premiums vary depending on the insurance company, its network, and any additional features, but the cost is often low (about $10 or $20 per month).
The third cost area is composed of the different deductibles, copays, and coinsurance amounts that you must pay out of pocket for services. These costs may also vary depending on whether you use in-network (network participating) or out-of-network (nonparticipating) doctors and providers.
How to Choose a Plan
You need to weigh the potential benefits and risks associated with plans and decide which is right for you. But there are a few essential things to think about when making your decision.
Benefits that come with Part C Plans:
- Gives you more coverage and benefit flexibility
- Includes a cap on your out-of-pocket expenses
- Often includes prescription drug coverage
- Offers you fewer doctor, specialist, and hospital choices
- Except for emergencies, you can’t use it while traveling outside your state
- It may include premiums, deductibles, and additional costs
For a personalized recommendation on whether Advantage or Part A and B with a Supplement Plan might be better for you, use our Suggest-a-Plan tool.
Want to read more about this type of plan? Visit our 2017 Guide to MA Plans.