A Medicare Advantage plan is a private Medicare insurance plan that you may join as an alternative to traditional Medicare. You must continue to stay enrolled in both Medicare Part A and B while enrolled in your Medicare Advantage plan as Medicare pays the Medicare Advantage company to take on your medical risk. This is how Medicare Advantage plans are funded. In many cases, Medicare Advantage plans have zero premium charges to the member but copays and deductibles will exist.
Each Advantage plan has its own summary of benefits which will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, labwork and so on.
One nice thing about Medicare Advantage plans is that some of them offer benefits for routine dental, vision or hearing and gym memberships. When searching for Medicare Advantage plans with dental and vision, our experts here at My Medicare Network can help you compare those ancillary benefits between carriers.
In exchange for lower (and in many cases zero) premiums that Advantage plans offer, you agree to play by certain rules as most Medicare Advantage plans have HMO or PPO networks.
Medicare HMO networks generally require you to use only network providers, except in emergencies. You will need to select a primary care physician at application and that physician will coordinate a referral if you need to see a specialist. HMO’s are the most common form of Advantage plans available.
Medicare PPO networks allow you to see doctors outside the network but you’ll have substantially higher out-of-pocket spending to do so. It’s a personal decision which option is best for your situation, If you are deciding between Medicare Advantage and Medigap, you’ll want to consider some of the rules before you enroll.