A Medicare Advantage Plan is a type of health insurance offered by private insurance companies that provides an alternative way to receive Medicare benefits. These plans include all the benefits of Original Medicare (Parts A and B) and often include additional benefits such as prescription drug coverage, vision, hearing, dental, and wellness programs. With a Medicare Advantage Plan, a person's Medicare benefits are administered by the private insurance company rather than the government.
Medicare Advantage Plans come in different types, but two common types are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans.
HMO plans typically require members to choose a primary care physician (PCP) and receive a referral from their PCP before seeing a specialist. In most cases, HMO plans only cover care received from providers within the plan's network. If a member receives care from a provider outside the network, they may be responsible for paying the full cost of the care. HMO plans often have lower monthly premiums and out-of-pocket costs than PPO plans.
PPO plans, on the other hand, allow members to receive care from providers both in and out of the plan's network, but usually at a higher cost-sharing rate when out-of-network. PPO plans do not typically require members to choose a PCP or get referrals before seeing specialists. Monthly premiums and out-of-pocket costs for PPO plans are generally higher than those for HMO plans.
Both HMO and PPO Medicare Advantage Plans provide coverage for all Medicare Part A and Part B services and may offer additional benefits such as prescription drug coverage, vision, hearing, dental, and wellness programs. It's important to review the details of each plan carefully to ensure that it meets your specific healthcare needs and to understand any restrictions on care providers or hospitals.
We’re currently in the General Open Enrollment Period for Medicare, which runs from January 1st to March 31st. During this time, you can make changes to your Medicare coverage, switch from Original Medicare to a Medicare Advantage plan, or switch your Medicare Advantage plan. This period is available for anyone eligible for Medicare who wants to update their coverage for the upcoming year.