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Medicare Advantage

Medicare Advantage, sometimes referred to as Medicare Plan C, is an alternative to Original Medicare (Parts A and B). It provides additional benefits and coverage that Original Medicare alone does not.

Medicare Advantage vs. Original Medicare

Medicare Advantage is an “all-in-one” solution to Original Medicare. Under Original Medicare alone, medical equipment and services such as dental, vision, and hearing are not covered. Medicare Advantage, on the other hand, includes all of the coverage of Original Medicare with many additional benefits as well.

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Medicare Advantage vs. Medigap Supplemental Insurance

There are certain healthcare costs that are not covered by Original Medicare, such as out-of-pocket copayments and coinsurance. Medigap plans are intended to supplement these costs.

Medicare Advantage, on the other hand, provides additional benefits rather than cost coverage for Original Medicare. Medicare Advantage, for example, will cover the cost of hearing aids, but not your Part B copayments. Medigap, on the other hand, will cover Part B copayments but not hearing aids.

Medicare Advantage Plan Options

There are four common variations of Medicare Advantage plans, each covering their own necessary medical and healthcare needs. These plans are:

Special Needs Plans (SNPs)

  • Plans tailored to their group’s needs
  • Requires in-network care unless for emergencies or out-of-area dialysis
  • Offers full prescription drug coverage
  • Most require a primary care doctor
  • Check for limited membership requirements

Preferred Provider Organization (PPO)

  • Allows for out-of-network visits
  • Most cover prescription drugs
  • No primary care doctor required
  • Does not require specialist referrals

Health Maintenance Organization (HMO)

  • In-network care except for emergency visits, out-of-area urgent care, or out-of-area dialysis
  • Most cover prescription drugs
  • Most require a primary care doctor and specialist referral

Private Fee-for-Service (PFFS)

  • Allows out-of-network care by those who accept the plan’s terms
  • Prescription drug coverage depends on the provider
  • Does not require a primary care doctor
  • Does not require specialist referrals
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Finding a plan that best suits your healthcare needs is difficult—why not let us help? Our goal is your health and security above all else. If you would like to learn more about your coverage options and receive a free quote, give us a call at (423) 240-0794.