Medicare
Part C or Medicare Advantage is basically a combination of
Medicare Parts A and B, often providing additional coverage
at a much lower cost. Part C is provided to beneficiaries
through private insurance organizations. These organizations
are approved and funded by Medicare.
There are four types of plans recognized under Medicare
Advantage. These are PPO or Preferred Provider Organization
Plans, MSA or Medical Savings Account Plans, HMO or Health
Maintenance Organization Plans and PFFS, which stands for
Private Fee For Service Plans. Each of these four plans
offers different ways of providing coverage for beneficiaries.
PPO Plans provide a network of hospitals and physicians
from which Medicare beneficiaries may choose. Those in this
plan also have the option of choosing their own medical
provider, even if he or she is not part of their network,
for a higher fee. In addition, some PPO Plans provide prescription
drug coverage as well.
MSA Plans have two different parts. One is a higher deductible
plan and the other is a savings account. Medicare funds
the savings account every year with the amount needed for
coverage. This amount is typically less than your required
deductible. Under this plan, you are not required to choose
a PCP or primary care physician, although your plan may
provide a list of preferred medical providers that offer
services at a lower cost than your normal physician. Prescription
drug coverage is not included in MSA Plans.
HMO Plans provide you with a network of doctors, much like
PPO Plans. The difference is that with an HMO Plan, you
are only allowed to choose a doctor that is listed within
your network. You are also required to choose a PCP and
a referral from this PCP is required in order for you to
see a specialist. Some HMO Plans do offer prescription drug
coverage.
PFFS Plans offer the most flexibility with regards to choosing
doctors and hospitals. You are permitted to go to any doctor
or hospital that is approved by Medicare. You are not required
to choose a PCP under this plan or have a referral from
a doctor in order to see a specialist. PFFS Plans have rates
for hospitals and doctors that are determined ahead of time,
as well as rates for co-pay you may incur. Some PFFS Plans
do offer prescription drug coverage.
The cost of Medicare Advantage will depend on many factors.
While you are required to pay a premium for Part B depending
on your current income, Part C coverage premiums depend
on the plan that you choose. Your chosen plan will have
pre-determined co-pays and deductibles.
It is important to keep in mind that there may not be Medicare
Advantage plans available in your area. It is also important
to note that these plans may be canceled at any time by
the company providing them, depending on whether or not
that company is earning a profit. You should spend some
time reviewing that plans that are available in your area
and choose the one that will offer you the best options
regarding coverage, physician choices and price.