Some Medicare recipients choose to get their care through private health plans.
Some people just prefer private health care. So, when you turn 65 or find yourself disabled, what are your options for getting the health care you want if that is your preference? Medicare+Choice (now known as Medicare Advantage) offers private health care for Medicare recipients.
What It Is
Medicare Advantage is simply an alternative way of receiving your Medicare benefits. Rather than get your Part A (hospital care) and Part B (outpatient care) through original Medicare, you can elect to get your benefits through Medicare Advantage, which is administered by private health-care plans. These plans are paid subsidies by the federal government.
Most Medicare Advantage plans are also packaged with a Part D drug plan as well.
History
In 1997, legislators looked to reduce Medicare payments. One idea that ended up in the Balanced Budget Act of 1997, was to give consumers the opportunity to receive their care through private health plans. In the act, these were named Part C, or Medicare+Choice.
In 2003, the Medicare Prescription Drug, Improvement and Modernization Act was passed. This was a huge overhaul of Medicare law, and due to the changing nature of Medicare, Medicare+Choice plans were turned into Medicare Advantage (MA) plans.
Types of Plans
The Medicare Advantage plans offered are as varied as health insurance is itself. Medicare Advantage plans are typically seen as Heath Maintenance Organizations (HMOs), Preferred Provider Organization (PPOs) and Private Fee-For-Service (PFFS) plans.
Other plans include Special Needs Plans (SNPs), which are typically reserved for those with special needs or particular diseases such as diabetes or cancer, Provider Sponsored Organizations (PSOs) and Medicare Medical Savings Accounts (MSAs).
What They Cover
Under Medicare law, Medicare Advantage plans must cover the same basic things that original Medicare covers. However, many MA plans go above and beyond this coverage to include some things that original Medicare does not cover, including dental and vision.
Benefits
The biggest benefit of choosing an MA plan is the extra services that may be covered. Besides dental and vision, an MA plan also may cover routine checkups and preventive services.
MA plans are often packaged with a drug plan, making Medicare simpler for some people who might otherwise need to deal with multiple companies.
Disadvantages
Those extra services come with a price. MA plans often cost more, and they sometimes have more restrictions on coverage.
If you select an HMO or PPO, your options may be limited. While Medicare is accepted nationwide, if you enroll in a private health plan, you will most likely be locked into a coverage network, meaning you can only see the doctors in your network to receive the full amount of coverage. This can sometimes result in problems getting the care you need if a specialist is out of the network or if you're traveling.
Tags: Medicare Advantage, Advantage plans, Medicare Advantage plans, private health, Medicare Choice, care through
