If you want comprehensive Medicare coverage with lower out-of-pocket costs than Original Medicare, a Medicare Advantage Plan may be right for you. These plans combine hospital, prescription drug, vision, and hearing coverage into one plan with a monthly premium, out-of-pocket maximums, and benefits designed to meet your specific health needs. Choose from a variety of plan types including HMO, PPO, and regional PPOs, as well as Medicare Advantage Special Needs Plans (SNP). Learn more about how Medicare Advantage Plans can provide the coverage you need and help manage your healthcare costs effectively.
Medicare Advantage plans are private health insurance plans approved by Medicare that offer an alternative to Original Medicare. Medicare pays a set amount each month to Medicare Advantage Plan companies for each beneficiary they cover, but these plans can decide how much to charge for services and can limit your choice of doctors, hospitals and other providers that you can use. Plans can also impose rules on how you get care, such as whether you need a referral to see a specialist or if a certain kind of service isn’t covered at all. Plans can also change benefits and cost sharing each year, so it’s important to review your options.
The majority of Medicare Advantage enrollees are in Medicare Advantage Part C (Medicare Advantage with prescription drug coverage) plans, also known as Cost Plans. These plans include both Parts A and B of Medicare and typically have lower premiums than other Medicare Advantage Plans, but they may have different rules for getting care. For example, most Cost Plans require you to get all your care from in-network doctors and providers. This can affect your flexibility in choosing doctors, especially if you have long-standing relationships with your physicians. In addition, Cost Plans don’t always cover all services that are available in traditional Medicare, such as home health services, non-emergency transportation to and from the hospital and a wide range of rehabilitative therapy services like physical, speech and occupational therapy.
A small share of Medicare Advantage enrollees are in a Medicare Special Needs Plan, also known as a SNP. These are plans that are designed to help people with chronic conditions, such as diabetes or heart disease, manage their care. These plans usually have low out-of-pocket costs for things like drugs, doctor visits and hospital stays, and often provide additional support services like telemonitoring or in-home care to help with activities of daily living.
Demonstrations and pilot programs are special projects that test improvements to Medicare coverage, payment or quality of care. They are usually only available for a limited time, or to a particular group of people, or in a certain area. For instance, some demonstrations focus on primary care, care related to specific procedures like hip and knee replacements, cancer treatment, or care in a skilled nursing facility or rehabilitation setting. Others are focused on new ways to deliver services and care, such as home and community-based services, or ways to improve the quality of care you receive. If you’re interested in a particular demonstration or pilot program, be sure to check with the program directly to learn more about how it works and how to enroll.