What is a Medicare Advantage Plan?
Similar to Medicare Supplement plans, Medicare Advantage plans (also known as MA plans, MAPD plans, or Part C) are private healthcare plans that can be purchased to fill some of the gaps that Original Medicare does not cover. But unlike other options that simply “tack on” their coverage to what is offered by Original Medicare, Medicare Advantage plans replace your Original Medicare coverage. When you purchase a plan of this type, you will NOT use your Original Medicare card when seeking healthcare.
What’s included in Medicare Advantage coverage?
Per the guidelines set-forth by the Center for Medicare and Medicaid Services (CMS), your Medicare Advantage plan is required to cover all of the medically necessary services covered by Original Medicare. Additionally, these plans frequently include prescription drug coverage and set a cap on your maximum out-of-pocket costs for each calendar year.
How does this coverage work?
Two key differences distinguish Medicare Advantage plans from other insurance options:
- These plans typically operate using a network structure. You can choose between an HMO plan (health maintenance organization) or a PPO plan (preferred provider organization). The network structure selected will determine the depth and breadth of doctors and facilities available to you as well as any guidelines you must follow regarding prior authorizations and referrals for service.
- Co-pays apply for many of the services received (doctor visits, hospital stay, tests, outpatient services, etc.)