Medicare Advantage Plans 

What is Medicare Advantage?

Medicare Advantage plans offer Medicare coverage through approved, private health insurance companies. Medicare Advantage plans provide all Part A and B benefits, as well as other services, such as vision, hearing, and wellness services.

What does Medicare Advantage Cover?

Medicare Advantage plans include:

  • All the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care, but not hospice care. However, because you must be enrolled in Part A to get a Medicare Advantage plan, your Part A benefit helps cover hospice care.
  • All the benefits of Medicare Part B, including doctor visits, outpatient care, screenings, shots and lab tests.
  • Prescription Drugs, if Part D prescription drug coverage is included in the Medicare Advantage plan (many do include this coverage). All Special Needs plans include Part D prescription drug coverage.

Some Medicare Advantage plans may include additional coverage for other services , including fitness benefits, routine hearing care, and routine vision care.

Medicare Advantage Coverage Limits

Because coverage limits vary by plan, you should look at the specific Medicare Advantage plan’s details to determine coverage limits or exclusions.

Plans that include prescription drug coverage may have additional restrictions, such as the cost-sharing amounts you pay for your medications.

What Doctors or Healthcare Providers are In-Network ?

Whether a doctor and healthcare provider are in-network varies by plan. In some plans, such as HMOs, your health care is coordinated through a primary care physician, who manages the care you receive from doctors, specialists and hospitals within the plan’s network. With these plans, only the services you receive from network providers are covered.

POS and PPO plans are also coordinated care plans like HMOs, but these plans let you receive covered services outside of the plan’s network, generally at a higher cost to you.

Non-network plans (like PFFS plans) let you receive care from any Medicare-eligible doctor or hospital that accepts the plan’s payment terms and conditions before providing you with care. No referrals are ever needed.

All of these Medicare Advantage plan types offer nationwide coverage for emergency care and urgent care. In these situations, you can go to the nearest doctor or hospital.

Finding health coverage for you and your family is an important and complicated decision. We know that healthcare coverage is one of the most important decisions you make, which is why we are here to help. We will work with you every step of the way as you consider your and your family’s healthcare needs, premiums, co-payments, deductables, coverage types, benefits, doctor flexibility, and plan limitations.

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