What to Look for In a Medicare Advantage Plan

Medicare Advantage plans become more popular every year. Since most plans include coverage for Medicare A and B plus Part D drug coverage, they are truly all-in-one plans. Clients are issued one card for all their Medicare health care needs. The carriers are private health insurance companies such as United Health, Humana, Aetna, Healthspring, Bright Health, and Anthem. These companies are compensated by Medicare for each client’s membership.

These are the major types of MA plans: HMO:

Health Maintenance Organization

HMO plans offer healthcare services via a specific network of providers. In most plans, clients choose a Primary Care Physician and referrals to Specialists are required. Networks are geographic.

PPO: Preferred Provider Organization

In a PPO plan, clients will pay less with doctors, hospitals, and other health care providers that are in-network. You pay more if you use doctors, hospitals, and providers outside of the network. Usually, referrals to Specialists are not required. Geographic networks.

PFFS: Private Fee for Service

PFFS plans aren't the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. You need to check with the provider to see if they accept payment from your specific plan carrier. Geographic networks.

SNP: Special Needs Plans Medicare

SNPs limit membership to people with specific diseases or characteristics. If you receive Medicaid and Medicare, you qualify for a SNP. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Geographic networks.



Here are a few things to be aware of when choosing a Medicare Advantage plan.

• What is the premium?
• What is the Maximum Out of Pocket? This is your safety net. When copays and co-insurance charges for Parts A and B reach a certain yearly amount, there are no further charges during the year.
• Is it a substantial network?
• Are your current providers in network?
• How about your hospitals? What are the copays for Dr. visits, hospital stays, outpatient surgery?
• How do you feel about being in a network?

There are more areas to consider, but the ones listed above are a good place to start in assessing which plan to choose.

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