Medicare Advantage refresher
Quick Medicare Advantage refresher
What is Medicare Advantage?
- It’s another name for Medicare Part C
- It is offered by private health insurance companies
- Plans can have $0 premiums
- Plus, extra benefits that Original Medicare doesn’t cover
Which plan should I choose?
Below we compare common kinds of Medicare Advantage plans. Download this chart as a PDF. You can also print it to keep it handy.
| Plan questions | HMO | PPO | PFFS |
|---|---|---|---|
| Does this kind of plan have a provider? | Yes | Yes | Yes |
| Does this kind of plan have in-network benefits? | Yes | Yes | Yes |
| Does this kind of plan have out-of-network benefits? | No (only in very limited situations, like for emergency or urgent care) | Yes (out-of-network benefits will usually cost you more than in-network benefits) | Yes (out-of-network benefits will usually cost you more than in-network benefits) |
| Do I need to pick a primary care provider (PCP)? | Yes (if you don't choose one, the plan may pick one for you) | No (but it’s a good idea to choose one) | No (but it’s a good idea to choose one) |
| Can I change my PCP at any time? | Yes | Yes | Yes |
| Does my PCP or specialist have to get approval in advance from the plan for me to get certain services? | This requirement may be different between plans - check the plan's documents | This requirement may be different between plans - check the plan's documents | No (but it’s a good idea to choose one) |
| If a plan has out-of-network services, do I have to get prior authorization? | This kind of plan does not have an out-of-network benefit | No | No |
| Do I have to get a referral from my PCP to see a network specialist? | This requirement may be different between plans – check the plan’s documents | This requirement may be different between plans - check the plan's documents | No |
| Do I have to get a referral from my PCP to see an out-of-network specialist? | This kind of plan does not have an out-of-network benefit | No | No |
| Which plan gives me the most freedom when getting care from a provider? | Yes Choose from in-network providers for most care | Yes
Yes
In-network providers and out-of-network providers who accept Medicare
| Yes
Yes
Yes
In-network providers and out-of-network providers who accept the
plan’s payment
|
| Does this kind of plan have a monthly premium? | This may be different by plan – check the plan’s documents | This may be different by plan – check the plan’s documents | Most PFFS plans will have one |
| Does this kind of plan have a maximum out-of-pocket amount? (This is the most you will pay for covered services during the year. If you reach this amount during the year, the plan will pay 100% for your care for the rest of the year.) | Yes | Yes (this amount is generally higher than on an HMO) | Yes (this amount is generally higher than on an HMO) |
| Does this kind of plan have a deductible for medical services?(I have to pay the full cost up to this amount. After that, the plan’s copays will kick in.) | This may be different between plans – check the plan’s documents | This may be different between plans – check the plan’s documents | This may be different between plans – check the plan’s documents |
| Does this kind of plan have predictable copays? | Yes | Yes (usually for in-network services) | Yes (usually for in-network services) |
| Does this type of plan offer extra benefits? Things like dental cleanings and fillings, eyeglasses, hearing aids, etc.? | Yes | Yes | Yes |
| Does this kind of play offer prescription drug benefits? | Depends on the plan you choose | Depends on the plan you choose | Depends on the plan you choose |
We hope this helps.
We hope you found this information useful. If you still have questions, give us a call. If a family member is helping you make decisions, have her or him call us. We want to make sure you get answers to your questions.
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