The Medicare Advantage program, once referred to as Medicare+ Choice, is a group of health insurance plans that entitle the subscriber to all Medicare- covered health services, often including prescription medication coverage. These plans may afford the subscriber extra benefits with lower co-payments when compared to the original Medicare plan, with the trade off of an extra monthly premium and requirement of choosing doctors and hospitals within the plan network. Subscribers of a Medicare+ Choice/ Medicare Advantage plan must also carry both Medicare Part A and Medicare Part B coverage. There are four Medicare+ Choice plan options to choose from.
Medicare Health Maintenance Organization (HMO):
Having widespread availability, this plan covers all Medicare A and B services when obtained from providers within the HMO network. The plan may cover extra hospital days and usually involves lower costs than the original Medicare plan.
Medicare Preferred Provider Organization (PPO):
Similar to the HMO plan, the PPO plan is based on region and covers all Medicare A and B services at a lower cost when obtained from an in network provider. Health services may be obtained from a provider who is outside of the PPO network for an additional cost.
Private Fee- for- Service Plan:
This insurance plan allows the subscriber to obtain services from any Medicare- approved providers who accept the plan. The insurance company, rather than Medicare, decides how much it will pay for certain services
and how much the subscriber will be responsible for. Coverage in this plan may go above and beyond what traditional Medicare will cover.
Medicare Special Needs Plan:
This plan is often limited to and more beneficial for individuals who require chronic illness and multiple disease management. In addition to members with chronic illnesses and multiple diagnoses, the plan is limited to subscribers in certain facilities such as nursing homes and those eligible for both Medicare and Medicaid.
Although this article gives a brief synopsis of plans under the umbrella of Medicare+ Choice/ Medicare Advantage, it is important to do your research into each plan and how it may benefit you as an individual. One helpful resource that may assist in your research is the Medicare website, found at www.Medicare.gov.