Medicare Advantage Plan

Medicare Advantage Plans, also known as “Part C” or “MA Plans,” are plans provided by private companies which are approved by Medicare. Joining a Medicare Advantage Plan doesn’t strip you off of Medicare but your Medicare Part A which covers hospital insurance and Medicare Part B which covers medical insurance is covered by your Medicare Advantage plan instead of original Medicare.

Services covered by Medicare Advantage Plan

If you are wondering about the services covered by Medicare Advantage Plan then let me inform you that you are likely to observe additional coverage of health services like vision, hearing and dental care that are not covered by an original Medicare plan. This makes it a better health insurance plan than original Medicare. Other services that are included in Medicare Advantage Plan are listed below:

The inclusion of health maintenance organizations.

The inclusion of favorable provider organizations.

Provision of private fee-for-service plans.

Provision of the special needs plan.

Provision for Medicare medical savings accounts plans.

So if you are enrolled in a Medicare Advantage Plan then you are covered by the plan for services which are also provided by original Medicare. The plan not only makes available those services that are covered by the original plan but also includes services that are not included under Original Medicare. This allows the beneficiary to save a lot of out-of-pocket costs that they might incur under Original Medicare. In fact, the majority of Medicare Advantage plans have provisions to provide with prescription drug coverage as well. Original Medicare doesn’t cover the costs of Prescription drugs which results in heavy expenditures from the end of the beneficiary.

Rules for Medicare Advantage Plans providers

The companies that provide Medicare Advantage Plans are given a pre-decided sum of money by Medicare to spend on the medical expenses of the beneficiaries enrolled with them. Therefore, these companies need to abide by the rules set by Medicare. These rules might change every year but for now, these are as follows:

Determine whether the beneficiary requires a referral to visit a specialist.

Determine whether the beneficiary requires visiting doctors, facilities or suppliers that are a part of the Medicare Advantage Plan for reasons that can’t be categorized for emergency reasons.

Each Medicare Advantage Plan might charge varying extra costs and provide varying services according to their particular set of rules.

 

Drug coverage in Medicare Advantage Plans

Majority of Medicare Advantage Plans are inclusive of prescription drug coverage as per Medicare Part D. However, in some cases, the prescription drug coverage does not include because either the plan is unable to offer drug coverage like the Medicare Medical Savings account Plans or they willingly choose to exclude drug coverage like some of the Private Fee-for-Service plans.

In case you are enrolled in a Medicare Advantage HMO or PPO plan and decide to enroll in a Medicare Prescription Drug Plan separately then you won’t remain a beneficiary of Medicare Advantage Plan and will be returned to Original Medicare.

For those wondering about Medicare Supplement Plan and its compatibility with Medicare Advantage Plan; these two plans can’t be taken together and are two separate plans.