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Medicare Advantage

Part C, also referred to as Medicare Advantage or MA/MAPD Plans, are another way to obtain Original Medicare (Part A and B) coverage, along with extra benefits not provided by Original Medicare. Eligibility for Medicare Advantage includes being enrolled in Original Medicare.

Extra Benefits

Some of the extra benefits that Medicare Advantage can provide includes:

  • Dental, vision, and hearing coverage
  • Prescription drug coverage 
  • Transportation to doctor visits 
  • Adult daycare services
  • Fitness memberships
  • Nutrition programs 
  • Wellness programs 

Keep in mind that not all MA/MAPD plans will have the same ancillary benefits.

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MA Plans

With Medicare Advantage, there are several different plans to enroll in:

  • Health Maintenance Organization: HMO Plans have lower premiums in return for stricter guidelines. Many HMOs require the beneficiary to stay within their network of providers. They also typically require a primary care physician to be selected, as well as receive referrals from that physician to see a specialist.
  • Preferred Provider Organization: PPO Plans are quite the opposite of HMOs. PPOs do cost more, but they offer more flexibility in return. This means the beneficiary can go outside the network of providers to receive care. They also do not have to select a primary care physician or receive referrals.
  • Private-Fee-For-Service: PFFS Plans will choose how much you pay for your care, and how much they will pay the doctor, provider, and hospital. With PFFS, you may or may not be required to stay within the network. However, you are not required to select a primary care physician or obtain referrals.
  • Medical Savings Account: MSA Plans combine a high deductible plan and savings account. You have to meet the high deductible in order for the plan to start its coverage. The plan will also deposit money into the savings account which you can use to pay towards your medical costs.
  • Special Needs Plan: SNPs are limited to individuals with specific diseases or characteristics. For most SNPs, it is required of the beneficiary to stay within the plan’s provider network, choose a primary care physician, and obtain referrals. However, these plans specifically tailor their benefits to meet the beneficiaries needs, and are required to provide prescription drug coverage.

For more information about which Medicare Advantage Plan may be right for you, contact Rothrock Insurance Solutions. We will walk you through each plan!