Medicare Advantage Policies: How Do They Work?

​While many people have health coverage from their Original Medicare, there are some who decide to get a Medicare Advantage (MA) plan. MA is also called Part C or Medicare private health plan. The federal government contract with these Medicare Advantage plans and each person pays a fixed amount to be able to get the benefits.

Types of Medicare Advantage Plans

• HMOs. With Health Maintenance Organizations, you need to use healthcare providers within a specified plan network. To consult with a specialist, you may need to obtain a referral from a primary care physician. 
  
  
• PPOs. With Preferred Provider Organizations, there is no need to get a referral to visit a specialist. You need to use preferred healthcare providers within an established network. If you continue to stay in your network, PPOs will likely pay for your medical costs.
  
  
• PFFS. These Private Fee-for-Service plans assess the amount they will pay the healthcare providers. PFFS also determine the amount that the beneficiary will pay for the out-of-pocket.
  
  
• MSA. Before identifying the deductible, the Medical Savings Account plans will put money in your healthcare checking account as a deposit for the healthcare costs. 
  
  
• SNP. These are Special Needs Plans, which are tailored for individuals who have certain health conditions. 

Note that the Medicare Advantage plan you choose comes with different guidelines, limitations, and costs. These factors can affect when and how you get the care you need. They also include certain benefits such as vision and dental care, which are not included in Medicare. 

Medicare Advantage plans have different 

• Coverage rules
• Cost-sharing for covered services
• Premiums (aside from Part B premium)
• Networks of providers

Eligibility
You may qualify for a Medicare Advantage plan if you reside in the service area of the plan, you have both Medicare Part A and Part B, and you have no End-Stage Renal Disease or ESRD. 

You may enroll automatically enroll in a Medicare Advantage plan that your employer or union sponsors. The changes you make in your health coverage may affect the benefits you receive. So, consult with your employer or union first about it.

Conclusion
Different companies follow different rules even though they offer the same MA plans. Learn about a plan and know what does it cover. 

At Simplified Insurance Solutions, we put our clients first by offering them policies that they can afford. Having insurance is a necessity nowadays and we're here to help you out. Learn more about our products and services by calling our agency at (888) 340-7633. You can also request a free quote by CLICKING HERE.