Coverage: There are primarily four kinds of Medicare Advantage (Medicare Part C) plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS) and Provider Sponsored Organizations (PSOs). Prior to MMA, the most commonly available types of these plans were HMOs and PPOs which, in most cases, require you to use provider networks. That means you can only use their approved hospitals and doctors in order to receive full plan benefits.

Unlike HMOs and PPOs, PFFS plans have no formal provider networks. However, not all doctors and hospitals are willing to treat plan members. Make sure to check if your current providers accept the PFFS plan’s payments before you enroll. Also, PFFS plans decide how much you pay for Medicare-covered services and may charge more for benefits than the original Medicare program.

At a minimum, Medicare Advantage plans must cover everything Part A and Part B do. Some plans provide additional benefits.

Administration: Private companies administer Medicare Advantage plans. These companies, called Carriers, receive funding from the Federal Government to administer the plans.

Enrollment: Enrollment in a Medicare Advantage plan is optional and voluntary. A Medicare Advantage plan is another way to receive your Part A and Part B coverage. You must be eligible for Part A and Part B to enroll in a Medicare Advantage plan.

Cost: Depending on the benefits they provide, some Medicare Advantage plans may charge a plan premium in addition to the Part B premium, while others do not. You must continue to pay your Part B premium to the Federal Government and the Government then provides funding to the Medicare Advantage plan.

There are usually co-payments for all covered services (for each doctor’s office visit, each day of hospital confinement, etc). You are NOT allowed to purchase insurance to supplement Medicare Advantage plans — you must pay all co-payments out of your own pocket. These co-payments can change annually.



Sources Referenced

• www.medicare.gov
• Medicare’s Medicare & You
• Centers for Medicare & Medicaid Services
• Senator Bob Dole’s Ten Things You Need To Know About Medicare’s New Prescription Drug Coverage
• Walgreens’ Introduction to Part D: Medicare’s New Prescription Drug Coverage
• Kaiser Family Foundation’s Talking About Medicare: Your Guide to Understanding the Program