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Medicare Advantage Options: Making a Correct Decision

In case you have any confusion regarding the exact definition of Medicare Advantage Plans, here’s the definition given by Centers for Medicare and Medicaid Services (CMS).

Medicare Advantage Plans

Medicare Advantage Plans are a part of Original Medicare. If you are enrolling yourself in a Medicare Advantage Plan, it does not imply that you are dis-enrolling for Medicare. You will still be under Medicare; your Advantage Plan is being controlled by some private insurance firm that is liable to follow the rules defined by Medicare.

Medicare Advantage Plan is different from Medicare Supplemental insurance. Medicare supplementary insurance (Medigap) works concurrently with Medicare Part A and B in order to provide extra coverage where original Medicare stops short. This plan can be purchased along with your original Medicare.

Thus, the first thing we ought to know prior to purchasing a Medicare Advantage Plan is that we are not purchasing Medicare Supplemental insurance.

About Medicare Advantage Plans:
When selecting a Medicare Advantage Plan for you, it is crucial to understand various kinds of plans that are available to you. Medicare Advantage Plans are of the following types:

  • Point-of-Service (POS): It is a kind of HMO plan that likewise allows you to avail certain services outside the plan's network at a higher price generally.
  • Health Maintenance Organization (HMO): The customer gets services from a large network of local physicians and hospitals who work unitedly to provide good care.
  • Preferred Provider Organization (PPO): In this plan, you can visit physicians and hospitals which are in the network or out of the network, but the services outside the plan's network usually cost more.
  • Special Needs Plans (SNP): This plan is suitable for the people living in a long-term care facility and who are eligible for both Medicaid as well as Medicare.
  • Private Fee-for-Service (PFFS): These plans generally are non-network plans from which one is able to receive care from any physician or hospital willing to accept the plan’s terms and conditions.

Medicare Advantage Plans - 2012Advantage Plans for 2012 cover the benefits of entire Part A (Hospital Insurance) as well as Part B (Medical Insurance) plans. It signifies that Medicare Advantage Plans tend to cover all the benefits under your Original Medicare. Nevertheless, these Advantage Plans can bill you different out-of-pocket costs. These are primarily the co-payments but can also be deductibles.

Medicare Advantage Plans combine the insurance coverage of Medicare Part A and Part B with some extra benefits. Most of the plans also provide Part D prescription drug coverage.

Advantage Plans work in the similar fashion as employer-sponsored medical insurance plans.  They assist an individual in continuing the same level of insurance coverage that he/she has now or in the past.

Choosing Medicare HMO Plans:
Considering the fact that there are lots of Medicare Advantage as well as HMO plans available in the market, it is quite important for you to pick the best insurance plan for you and your family.

Advantage Plans can also provide additional insurance coverage, like hearing, dental, health or vision programs. Most of the Medicare Advantage Plans also offer Medicare Part D prescription coverage.

PPO Advantage Plans:
PPO Advantage Plans are pretty predictable causing them to be highly in demand amongst the elderly people. Elderly people get to pick from a big network of physicians and hospitals with their PPO Advantage Plan. It is also possible to apply for a PPO plan in conjunction with Part D prescription drug coverage included or without the coverage.

What does your 2012 Medicare Advantage Plan include?

  • Your 2012 Medicare Advantage Plan comprises of all the benefits of Part A Medicare plus hospital stays, nursing fees, home care etc.. It must be mentioned that this insurance plan does not give you hospice care. Yet, considering the fact that you've got to be a part of Medicare Part A in order to purchase Medicare Advantage Plan 2012, Part A takes care of your hospice care successfully.
  • The Medicare Advantage Plan also comprises of the benefits of Medicare Part B including doctor visits, lab tests and screenings.
  • Medicare Part D prescription coverage is included in your Medicare Advantage Plan.
  • Several Medicare Advantage Plans also incorporate the benefits of additional services such as vision or hearing care.

Buying a PPO plan could be a right choice for you and your loved ones if you are fine with the network size, but prefer to have the flexibility of visiting multiple physicians and hospitals for medical care.

Medicare HMO Plans:
Medicare HMO plans are perfect for elderly people. Here in, one has to stay within the network of doctors and hospitals assigned. However, there are exceptions like out-of-network immediate care or emergency care.

HMO plans permits an individual to visit a doctor out of his network, but at a higher price. Part D prescription coverage is included most of the times and getting referrals is mandatory as well as choosing a primary physician.

Medicare HMO plan just might be your dream insurance policy in case you live in a large area.. This is due to the fact that it is comprehensive and cost sharing is quite low. On the contrary, if you are putting up in a small area with small network of doctors, a PPO plan would be ideal for you.

Medicare PFFS Plans: 
Medicare PFFS Plans provide immense flexibility and freedom, but getting covered services can sometimes be dicey. One does not require using network and is able to choose his/her own providers. However, this plan decides how much they will pay doctors and hospitals and how much they will pay for other services. Under this plan, one can visit any physician or hospital if they agree to cure you.

How do I enroll?
You would be able to join a Medicare Advantage Plan once you qualify for Medicare, or when the initial enrollment period starts. You will likewise require registering yourself for plans Part A and Part B at this point of time.

Once you have joined plans Part A and Part B, you cannot be declined insurance coverage by any insurance agent in your region. Yet, additional rules are applicable on the individuals suffering from end-stage nephritic disease.

Each private insurance firm that provides an Advantage Plan manages the registration procedure for its plans. You will require contacting the company directly and inquire about how to sign up.

Medicare Advantage Insurance Plans

Medicare SNP Plans:
Membership in SNP plans is basically confined to particular groups of individuals. A SNP plan could just be a right plan for you if you are eligible for enrolling in both Medicaid as well as Medicare, or you are a resident of certain kind of institutions like nursing homes or if you are suffering from some chronic illness. Medicare Part D is invariably included in this plan and it must be kept in mind that SNP plans are meant to meet your needs by providing you a greater degree of co-ordinated case and care management.

Are there any limits to coverage?
Coverage limits differ from plan to plan. Thus, one has to look at the details of the specific Medicare Advantage Plan to see what its coverage limits are.

Advantage Plans that comprise of Part D prescription drug coverage might have extra restrictions like cost-sharing amounts that one pays for his/her medicines.

What are the 'Advantages' to a Medicare Advantage Plan?

  • Great value for money, with many Medicare Advantage plans costing next-to-nothing
  • Medicare Advantage plan subscribers still keep the same benefits received through plans A and B
  • More options are added all the time, with practically every county in every state benefitting, compared to just 12% in 1995
  • Whatever your health condition, your out-of-pocket expense is capped at a set fee, as compared to Medigap policies which will have a customer paying up to $2,000.00, regardless of whether they have used the service
  • Visit any doctor, any time, no matter where you are in the country with a PPO or PFFS permit

It would be our pleasure to offer you the best plan for your requirements from an A rated insurer today. Contact us today and benefit from one of these leading Advantage plans.

Read our Complete Guide to Medicare Insurance

Medicare Advantage Plan
Monthly Payments (Average)
Number Of Medicare Advantage Contracts
Medicare Advantage Plan Penetration
 
United States $734 United States 428 United States 17.5%
 
Alabama $692 Alabama 41 Alabama 15.2%
Alaska NA Alaska 39 Alaska 0.5%
Arizona $651 Arizona 50 Arizona 30.1%
Arkansas $640 Arkansas 39 Arkansas 8.23%
California $652 California 52 California 30.7%
Colorado $649 Colorado 37 Colorado 28.2%
Connecticut $681 Connecticut 40 Connecticut 9.1%
Delaware $658 Delaware 37 Delaware 2.23%
District of columbia $776 District of columbia 41 District of columbia 8.12%
Florida $840 Florida 74 Florida 23.1%
Georgia $680 Georgia 49 Georgia 8.1%
Hawaii $639 Hawaii 41 Hawaii 34.4%
Idaho $647 Idaho 40 Idaho 18.2%
Illinois $680 Illinois 56 Illinois 7.22%
Indiana $641 Indiana 45 Indiana 9.5%
Iowa $618 Iowa 42 Iowa 11.8%
Kansas $675 Kansas 44 Kansas 6.2%
Kentucky $653 Kentucky 45 Kentucky 8.4%
Louisiana $855 Louisiana 42 Louisiana 16.1%
Maine NA Maine 38 Maine 2.23%
Maryland $815 Maryland 41 Maryland 5.5%
Massachusetts $737 Massachusetts 42 Massachusetts 14.2%
Michigan $816 Michigan 44 Michigan 14.1%
Minnesota $645 Minnesota 40 Minnesota 26.2%
Mississippi NA Mississippi 38 Mississippi 6.51%
Missouri $663 Missouri 45 Missouri 15.2%
Montana $591 Montana 38 Montana 11.2%
Nebraska $650 Nebraska 37 Nebraska 8.21%
Nevada $757 Nevada 41 Nevada 29.1%
New Hampshire $653 New Hampshire 33 New Hampshire 2.1%
New Jersey $807 New Jersey 42 New Jersey 8.2%
New Mexico $651 New Mexico 41 New Mexico 20.1%
New York $811 New York 64 New York 21.2%
North Carolina $647 North Carolina 40 North Carolina 13.3%
North Dakota $591 North Dakota 37 North Dakota 5.51%
Ohio $674 Ohio 54 Ohio 17.1%
Oklahoma $666 Oklahoma 42 Oklahoma 11.3%
Oregon $647 Oregon 53 Oregon 34.3%
Pennsylvania $778 Pennsylvania 59 Pennsylvania 31.1%
Rhode Island $655 Rhode Island 37 Rhode Island 30.2%
South Carolina $646 South Carolina 43 South Carolina 8.22%
South Dakota $591 South Dakota 36 South Dakota 3.2%
Tennessee $655 Tennessee 47 Tennessee 16.1%
Texas $742 Texas 57 Texas 13.0%
Utah $644 Utah 40 Utah 16.5%
Vermont NA Vermont 34 Vermont 1.1%
Virginia $671 Virginia 43 Virginia 8.7%
Washington $644 Washington 47 Washington 19.1%
West Virginia $707 West Virginia 40 West Virginia 6.23%
Wisconsin $618 Wisconsin 46 Wisconsin 18.2%
Wyoming NA Wyoming 35 Wyoming 2.3%
jm 392 35 10152011
av 1423 220 12142011