What is a Medicare Advantage (MA) Plan?
A Medicare Advantage Plan (like an HMO or PPO) is a Medicare health plan choice you have as an option being eligible for Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
Medicare Advantage plans combine your Part A (hospital) and Part B (medical) into one source of coverage. Most Advantage plans also include Part D (prescription drug) coverage. In addition to medical and prescription drug coverage, most plans offer added benefits like dental, vision, hearing, over-the-counter drug coverage and transportation.
Coverage Rules in Medicare Advantage Plans
Medicare Advantage Plans must cover all of the services that Original Medicare covers. When you are in an MA plan, you still have Medicare. There are several types of MA plans including:
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Health Maintenance Organization (HMO) Plans
Provides coverage for plan members through a network of locally contracted providers. Members in HMO plans must use plan providers (sometimes called “in network” providers), except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor your provider/facility (and all subsidiaries) will be responsible for the costs.
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Preferred Provider Organization (PPO) Plans
Provides coverage for plan members through a network of locally contracted providers. Members in PPO plans can go to any doctor, specialist or hospital whether they are in or out of network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.
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HMO Point-of-Service (HMOPOS) Plans
Provides coverage for plan members through a network of locally contracted doctors and hospitals. Members in POS plans may use a provider who is not in network for some services. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers. While the POS option provides more flexibility and choice, it is important to remember that not all services are available outside the network of contracted providers.
For detailed coverage information for any MA plans, please refer to the plan’s Evidence of Coverage.