WHAT IS A MEDICARE ADVANTAGE (PART C) PLAN
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A type of Medicare Health Plan offered by private insurance companies who contact with Medicare. Medicare Advantage Plans provide all of your Medicare Part A (hospital) and Medicare Part B (medical) benefits, all under one privatized plan. Many Medicare Advantage Plans also include additional benefits like Part D (prescription) coverage, Dental, and Vision benefits. You must have both Medicare Parts A and B to be eligible to enroll into a Medicare Advantage Plan.
There are several types of Medicare Advantage Plans:
|Type of Medicare Advantage Plan||Description|
|Health Maintenance Organization||HMO||In general, with most HMO plans, you must get your care and services from providers within your plan's network (except for emergency care). If you receive health care services outside of your plan's network, you may have to pay the full cost. You may also need a referral from your designated Primary Care Provider to receive coverage for other services (e.g. Specialists).|
|Health Maintenance Organization with Point-Of-Service Option||HMO-POS||HMO-POS plans act like HMO plans, and require a designated Primary Care Provider, however you may be able to go out-of-network for some services. It will usually cost a lower cost share if you receive your care from in-network providers.|
|Preferred Provider Organization||PPO||In general, you'll pay a lower cost sharing if you use doctors, hospitals, and other health care providers that belong to the PPO plan's network, but you have the flexibility to receive care from doctors, hospitals, and specialists that aren't in the plan's network (usually at a higher cost). In most cases you do not need a referral to see a Specialist.|
|Special Needs Plan||SNP||A type of Medicare Advantage Plan (like an HMO or PPO), but eligibility is limited to people with specific diseases or characteristics (e.g. people with chronic illnesses, or with Medicare and Medicaid eligibility). Medicare SNPs tailor their benefits to meet the specific needs of the groups they service.|
|Private Fee-For-Service||PFFS||PFFS plans are not the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, hospitals, and other health care providers, and how much you must pay when you receive care. You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. You can also choose providers out-of-network who accept the plan's terms, but your costs will usually be lower if you stay in the network. You do not need to get referrals to see specialists in PFFS plans.|
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