Medicare Advantage Plans Explained

Medicare is government health insurance for U.S. citizens over 65 years old and disabled people of any age. As with any government program, the terms can be confusing, but the most important thing to remember is that Medicare is not the same for everyone, and you can choose a plan to fit your individual health needs. You may need to fill in some gaps in standard Medicare services, and Medicare Advantage plans allow for greater flexibility and choice in your health care. To help you figure out if this route is right for you, here is a short guide to understanding Medicare Advantage.

The health insurance system is composed of four parts, each of which covers a different aspect of health care. Medicare Advantage Plans are sometimes called “Part C” and provide all the benefits of the original medicare plan, plus extra coverage. Subscribers generally pay a fixed amount each time they see a doctor. The added coverage may include as dental, vision or hearing care. Medicare itself does not provide these services but pays private companies a fixed monthly amount for offering Advantage plans. The companies must follow Medicare guidelines in order to participate, and they may charge you an additional monthly premium to join.

Types of Medicare Advantage plans
Medicare Advantage plans are much like telephone plans — services, costs and terms vary with each company. Health Maintenance Organization (HMO) plans require you to use health care professionals within a selected network, and you will typically need a referral from your primary health physician to visit a specialist. Preferred Provider Organization (PPO) plans also list participating physicians, but you may not need a referral to choose another health care provider from the network. A Private Fee-For-Service (PFFS) plan might not have a network of doctors at all. Instead, each unique health care provider decides whether or not to accept the plan’s terms. Special Needs Plans (SNP) serves people with particular health requirements, such as individuals with chronic heath conditions like HIV/AIDS, congestive heart failure or a mental health condition.

The costs
How much a Medicare Advantage plan will cost depends on the terms of each plan. Some plans charge a monthly premium on top of what you would pay for the original Medicare plan. You may have to contribute a small share of the costs for every service, usually in the form of copayment (a fixed amount) or coinsurance (a percentage of the cost). Medicare Advantage plans charge according to the types and number of services you will get. For example, one plan may provide coverage only for preventative dental health insurance while another plan also covers oral surgery. Each plan will have a different annual limit to your out-of-pocket costs.

How to join
Take note that you can only enroll in plans at particular periods during the year. You can join a Medicare Advantage plan when you first become eligible for Medicare or during a yearly enrollment period which usually takes place in the fall. Special Enrollment Periods (SEPs) allow you to join after particular life events, such as moving or losing insurance coverage. Before you enroll, you should research the plan that suits you. Factors to consider include location, whether you need special health services and your budget. For more information on Medicare health plans, including how to find plan providers, visit the official website at