Medicare Advantage Plan: What is it exactly?

Medicare Advantage Plan overview:

The Medicare advantage plan is provided as an alternative to the original Medicare plan, depending upon where your loved one lives. Private insurance companies also provide coverage similar to the Medicare advantage plan. Frequently they offer broader coverage but limit which doctors, hospitals, and other health-care providers that your senior may visit for services.

If your parent or loved one decides to utilize a Medicare advantage plan, they will still be in the Medicare program, and will still get coverage included in Part A. and Part B of the original Medicare plan.

Medicare advantage plans usually fall under one of the following four categories.

Managed-care. Under managed-care plans, your senior can only go to doctors and other providers within the managed-care network. Also, in most cases referrals to specialists are made through primary care doctors. Doctors can leave the plan at any time and your senior needs to make sure that their current doctor is not thinking about leaving the plan in the future.

Some managed-care plans offer an option called “point of service” which means that your senior may go to doctors and hospitals outside of the network, but they may have to pay deductibles and coinsurance to do so.

Preferred provider organization. These organizations are similar to managed-care plans except that your senior can see specialists without referrals from primary care doctors. In some cases, your loved ones can see any doctor or other health care provider who accepts Medicare, although, they may have to pay an extra charge if the provider is not within the plans “network”.

Private fee-for-service. These plans operate much like the original Medicare plan except that are private company, rather than Medicare, determines the “approved fees”, premiums, deductibles, coinsurance, and co-payments. Your senior may go to any physician or hospital approved by Medicare who has decided to accept the plan’s fees as their payment.

Specialty plan. These plans are relatively new in that they provide normal Medicare coverage, plus they pay for any extra care that is needed because of a specific disorder or disease (such as renal disease, congestive heart failure, or diabetes).

In summary, Medicare Advantage Plans come in many forms with many being very similar to the original Medicare plan. You should continue to learn all that you can in order to make sure that your loved one gets the services that they need through either their original Medicare plan or through one of these Medicare Advantage Plans.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting

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