Medicare Advantage

Part C, also known as Medicare Advantage, is an alternative to Original Medicare that offers additional benefits and decreases your overall healthcare cost.

However, to be eligible for a Medicare Advantage plan, you must first enroll in Parts A and B. Afterward, you can then decide to stay with Original Medicare or enroll in a Medicare Advantage plan.

Types Of Medicare Advantage Plans

There are five kinds of Medicare Advantage Plans:

  • Medicare Medical Savings Account (MSA) 
  • Private-Fee-for-Service (PFFS) 
  • Preferred Provider Organization (PPO) 
  • Health Maintenance Organization (HMO) 
  • Special Needs Plans (SNPs)

While all of these options function similarly, there are some differences in their structures and pricing.

A Special Needs Plan (SNP) is meant for very specific individuals. You can qualify for a D-SNP if you’re eligible and enrolled in Medicaid and Medicare. If you have a chronic condition, as highlighted by the CMS, you’re eligible for a C-SNP.  If you live in (or are expected to live in) a long-term care facility for over 90 days, you’re eligible for an I-SNP.

HMO plans limit coverage to medical care from healthcare professionals that are within their given provider networks. These plans don’t provide out-of-network healthcare except in cases of emergencies. Some HMO plans need you to live in their service areas for eligibility, and most require you to get referrals and a primary physician.

PPO plans don’t require referrals or primary physicians. You can use them to obtain healthcare from various providers since they typically cover a wider area.

With PFFS plans, you can see which providers agree to the terms and receive coverage from them. Your plan determines how much the provider pays for your healthcare and how much you do.

MSA plans combine a high deductible with a bank (savings) account. You have to meet the deductible before the plan provides you with coverage. The MSA plan deposits money into the savings account that you use to meet your deductible.

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Medicare Advantage vs. Original Medicare

Your Medicare Advantage plan will cover everything included in Parts A and B, no matter which plan or insurance provider you choose. It also offers you extra benefits that Original Medicare doesn’t cover.

Advantage plans also offer lower out-of-pocket payments than the Original Medicare option. You’ll have to pay low or no monthly premiums, thereby cutting down the cost coverage. 

There is no right or wrong answer as to which part of Medicare would work best for you, but you should really consider the type of coverage you need and what you can afford as this will ultimately hint at which plan you should enroll in.

Find The Best Part C Plan For You

Getting started with Medicare can be challenging to navigate, but we’re here to make the process easy for you. At Scott Sims Insurance, we’ll lay out your options for you and explain each of them so you can compare them.

If you need to learn more about Advantage plans, contact us today at (541) 915-0939.