Medicare Advantage (Part C)

  • Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare. Provided by third party/private insurers, these plans include Part A, Part B, and Part D.
  • Plans also often include extra coverage such as for vision, hearing, dental, and more.
  • Medicare Advantage Plans are contracted through Medicare and must follow its coverage rules.

Eligibility:

Must be enrolled in Part A and Part B

Live in the plan’s service area

Do not have renal disease (exceptions apply)

Health Maintenance Organization (HMO)

 

 

o Members must use doctors and hospitals within a provided network

o Plans usually have strict guidelines

o Usually need a general practitioner’s referral to see a specialist

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Preferred Provider Organization (PPO)

 

o Offer a network of hospitals and doctors, but not required to choose from within it to be covered

o Choosing out of network can lead to higher out-of-pocket costs

o Primary care doctor is not a requirement, do not need a referral to see a specialist

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Private Fee-For-Service (PFFS)

o Can visit any Medicare-approved doctor, clinic or hospital, as long as they accept the payment terms and conditions of your insurance

o Providers must contract with your insurance each time treatment is received

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Special Needs Plans (SNPs)

 

o Limited to those with chronic illnesses, need to be institutionalized, or are enrolled in their State Medicare and Medicaid

o Benefits are tailored to the needs of each member

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Medicare Medical Savings Accounts (MMSA)

  • Combination of a high deductible Medicare plan with a savings plan.
  • MSA puts money in a savings account each year and when you need treatment, you use the savings to pay for deductible. Once the deductible is reached, the plan starts to pay for the treatment.
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