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Oct. 19, 2020, 3:27 p.m. EDT

Medicare Advantage plans: What you need to know

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Key Takeaways:

Medicare Advantage plans, also known as Medicare Part C, offer a combination of Medicare parts and numerous health services including hearing, dental, vision and prescription drug coverage.

Even though Medicare Advantage is run by private companies , there are many federal protections built into it. For example, Medicare Advantage plans are required to cover everything that Original Medicare covers .

You are eligible to join a Medicare Advantage plan if:

There are several types of Medicare Advantage plans from which to choose. Note that each plan has different rules for how you get services, including:

Those and other rules can change each year, so be certain to review your plan annually. If you are ready to discuss your eligibility or want to understand what plans are available in your area, you can dial 844-259-6504 to speak with a licensed insurance agent or you can request a free quote from MedicareExpertUSA.com .

Here are the most common Medicare Advantage plans: 

With HMO plans , you have to get your care and services from providers in the plan’s network. In most cases, prescription drugs are covered. You will need to select a primary care doctor under this plan. If you need to see a specialist, your primary care doctor will give you a referral.

However, certain services, like annual mammograms, don’t require a referral. Be mindful that HMO plans usually don’t offer the following care and services:

With some HMO plans, you may be able to go out of network for certain services. However, you will most likely have to pay the full cost of the service for going out of the plan’s network.

A PPO is a Medicare Advantage plan that also has a network of doctors, other health care providers and hospitals. Just like HMO plans, you pay less if you use doctors, hospitals and other health care providers that belong to the plan’s  network

However, with Medicare PPO , you don’t have to choose a primary care doctor or get a referral to see a specialist. Also, like HMO plans, in most cases prescription drugs are covered in PPO plans. However, be certain to ask if the plan offers Medicare drug coverage. Remember, if you join a PPO plan that doesn’t offer prescription drug coverage, you can’t join a Medicare prescription drug plan (Part D).

A PFFS plan is a Medicare Advantage plan that determines how much it will pay doctors, other healthcare providers and hospitals for your care, and how much you must pay when you get care. You don’t have to choose a primary doctor or get a referral to see a specialist in PFFS plans. 

If you decide to join a PFFS plan that has a network, you can use any of the network providers who have agreed to always treat PFFS plan members. You can also choose an out-of-network doctor, hospital or other provider who accepts the PFFS plan’s terms, but your costs will usually be higher. Remember that Original Medicare (Parts A and B) won’t pay for your health care while you’re in the PFFS plan.

Be sure to check with the PFFS plan to see if prescription drugs are covered. If it doesn’t offer drug coverage, you can join a Medicare prescription drug plan (Part D)  to get coverage.

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