Medicare Advantage (Part C) are private health plans that contract with the federal government to provide the same Medicare benefits included with Original Medicare (Part A & B); however, different costs, rules, and restrictions may apply, and added benefits may be offered above what Original Medicare provides, such as: gym memberships, prescription drug coverage, health and wellness services, and transportation for doctor’s visits.

There are 5 different plan types under the Medicare Part C umbrella: Preferred Provider Organization Plans (PPO), Health Maintenance Organization Plans (HMO), Medicare Medical Savings Account Plans (MSA), Private Fee for Service Plans (PFFS), and Special Needs Plans (SNP).

Preferred Provider Organization (PPO) Plans offer a network of doctors, specialists, hospitals, and health care providers that you can choose to receive care from. Out-of-pocket costs are minimal if you stay in network. You can seek medical care outside of the network and still be covered, though not fully, so there may be some additional costs. Medically necessary emergency and urgent care are always covered though. Most PPO plans come with prescription drug coverage, but some don’t, so make sure you compare the plans. Some of the extra benefits that may be offered include: dental, vision, and hearing coverage, gym membership, transportation services, and even meal delivery.

HMO plans are generally more limited than Original Medicare. They don’t allow HMO members to see providers outside of their network, and if one does, they would be responsible for the full cost. The exception to this is in the case of emergent care or out-of-area urgent care. HMO plans are required to offer the same benefits as Original Medicare, with the option to include prescription drug coverage benefits. Extra benefits, such as: dental, hearing, and vision coverage, meal delivery, and transportation to and from medical appointments may also be found in these plans.

These plans combine a high-deductible insurance plan with a medical savings account Medicare funds that can be used to pay for health related expenses. You cannot fund your own Medical Savings Account. Once the Medical Savings Account runs out of money, you would be required to pay any expenses out-of-pocket until your deductible is reached. The funds used from the Medical Savings Account for Medicare Eligible expenses also count towards the plan’s deductible, and any funds still in the account at the end of the year will stay in the account to be used towards future expenses.

PFFS plans identify a set rate for all services you could receive. You are allowed to see any Medicare-approved provider, but some providers may not accept the terms of the plan. A list of in-network providers who have agreed to treat members of the plan is generally available. All PFFS plans must also cover out-of-network care received, though you may pay a higher cost. PFFS plans are not available in every state, so reach out with any questions about your particular state.

You don’t need to sign up for Medicare each year. However, each year it is recommended you review your coverage, and make any changes you need. Those who are currently on a Medicare Advantage Plan or Part D prescription drug plan can make any changes during the Annual Enrollment Period (Oct. 15 – Dec. 7). One can also qualify for a special election period to make changes outside of the Annual Enrollment Period in certain situations. Reach out to our team to discuss.