Understanding Medicare Advantage
A Medicare Advantage Policy, similar to a PPO, or HMO, is a type of Medicare policy available to Medicare participants. This option is also known as part of Medicare C. These policies are offered by Medicare-approved private health insurance companies. By participating in a Medicare health policy, a participant will receive virtually all Medicare A and Medicare Part B portions.
Medicare Advantage (previously Medicare + Choice) is a policy that enables Medicare beneficiaries to obtain benefits from private insurance. The government pays a certain amount to insurers to insure part of the policy, while insurers can offer a number of other benefits according to the rules set by Medicare and the Medicaid Solution Center. In many cases, prescription drug insurance (Medicare Part D) is included in Medicare Advantage policies.
Types of policies
Preferred Provider Organization (PPO): There are some Medicare Advantage policies which stipulate contracts with a network of health care providers (doctors, hospitals, etc.) and charge lower fees when subscribers use the services of these providers. Policy members may use external providers for additional costs. Health Management Organization (HMO): The HMOs also have a network of pre-approved service providers that are insured by the policy, but the main difference is that you must select a family doctor. The family doctor will act as a private physician and also as a health coordinator. If you have ever seen a specialist who is not part of your HMO policy network, your family doctor may provide a referral if you feel it is necessary. Your insurance will pay a portion of the expenses, but without that, you should expect to cover the full price.
Private Pay Service (PFFS): The PFFS policies function in the same way as the traditional Medicare system because they allow you to consult any provider that accepts the policy’s payment methods. Sometimes these policies establish a network of providers for certain categories of services, but allow you to see someone outside the network who accepts the payment of the policy. Special Needs Policy (NPS): The special needs policies are available for eligible Medicare individuals who also qualify for Medicaid, institutional, or chronically ill.
Physician Savings Accounts (MSA): Savings accounts for physicians, because of their large deductible, generally do not require a premium. Recipients must cover the Medicare Part B premium and also cover for Medicare insured services. Once the participant has reached the deductible, the policy will pay for Medicare services. Medicare deposits money into a savings account to pay for medical expenses. MSA policies do not include prescription drugs, but it is often possible to purchase a separate prescription drug policy. Find medicare advantage plans at www.medicareadvantage2019.org/ for 2019.
The Medicare benefit is useful because it does not usually require the purchase of a Medicare Protection Policy and typically offers extra benefits such as vision and dental benefits or “wellness” such as a subscription to a fitness center. Recipients who decide to benefit from Medicare Advantage are entitled to maintain the complete protection of normal Medicare patients and will have the full right to write a petition against the Center for Medicare and Medicaid services.When you receive offers for a Medicare Advantage policy, it is usually best to work with a company or agency that has access to more than one insurer. In this way, you can get a set of quotes to determine which one is right for you.