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Medicare Advantage

Medicare Advantage plans or “MA” plans are also called Part C. MA plans are available through private companies approved by Medicare. The insurance companies providing MA plans are under contract with Medicare and are paid by Medicare. The reason the private companies are paid is because they are paying your medical bills instead of Medicare. Rest assured: you are still part of Medicare with this type of plan, and still have all the same rights and protection.

There are four main types of Medicare Advantage plans: an HMO, PPO, PFFS, or SNP.

  • An HMO (Health Maintenance Organization) plan is the most restrictive plan. You may only go to doctors and hospitals that are in the provider’s network unless there is an emergency.
  • A PPO (Preferred Provider Organization) plan still has what they call “In Network” doctors and hospitals, but you are also allowed to go outside the network. If you go outside the network (known as “Out of Network”) you normally have higher co-pays or deductibles than you would if you would stay in the network.
  • A PFFS (Private Fee For Service) plan allows you to go to any doctor or hospital that would accept the MA plan’s terms and conditions. There is not a network with this type of plan. For the most part, PFFS plans were eliminated as of 2011.
  • A SNP (Special Needs Plan) says you generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network.  A plan must limit membership to these groups: 1) people who live in certain institutions (like nursing homes) or who require nursing care at home, or 2) people who are eligible for both Medicare and Medicaid, or 3) people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease, HIV/AIDS, chronic heart failure, or dementia).  Plans may further limit membership.

Most Medicare Advantage plans provide lower premiums but higher co-pays and deductibles than a Medicare Supplement.

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