Medicare Part C
There are primarily four kinds of Medicare Advantage plans: Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS) and Provider Sponsored Organizations (PSOs). Prior to the Medicare Modernization Act of 2003 (MMA), the most commonly available types of these plans were HMOs and PPOs which, in most cases, require you to use provider networks. That means you can only use their approved hospitals and doctors in order to receive full plan benefits. Plans can change the hospitals and doctors in their provider networks at any time.
Unlike HMOs and PPOs, PFFS plans have no formal provider networks. However, not all doctors and hospitals are willing to treat plan members. Make sure to check if your current providers accept the PFFS plan’s payments before you enroll. Also, PFFS plans decide how much you pay for Medicare-covered services and may charge more for benefits than the original Medicare program.
At a minimum, Medicare Advantage plans must cover everything Part A and Part B do. Some plans provide additional benefits.
Private companies administer Medicare Advantage plans. These companies receive funding from the Federal Government to administer the plans. Carriers don’t have to guarantee the coverage they provide from year to year. Each year they can change the benefits provided in their plans; they can change the Service Areas they cover; or they can decide to discontinue their plans.
Enrollment in a Medicare Advantage plan is optional and voluntary. A Medicare Advantage plan is another way to receive your Part A and Part B coverage. You must be eligible for Part A and Part B to enroll in a Medicare Advantage plan.
Depending on the benefits they provide, some Medicare Advantage plans may charge a plan premium in addition to the Part B premium, while others do not. You must continue to pay your Part B premium to the Federal Government and the Government then provides funding to the Medicare Advantage plan.
There are usually co-payments for all covered services (for each doctor’s office visit, each day of hospital confinement, etc). You are NOT allowed to purchase insurance to supplement Medicare Advantage plans–you must pay all co-payments out of your pocket. The co-payments can change annually.
To see another comparison of these plans to traditional Medicare, click on the following link: Medicare vs. Medicare Advantage
