About Medicare Advantage Health Plans

If you are about to enroll in Medicare, the government-sponsored health insurance program for people 65 and over, there are some options available to you. You could enroll in traditional Medicare, which includes Part A (hospitalization), Part B (doctor visits) and possibly Part D (prescription drugs) to meet your health care needs. As an alternative, you could enroll in a Medicare Advantage plan, also known as Medicare Part C.

History

• Medicare Advantage (MA) traces its roots to 1997 when Congress created Medicare+Choice to allow Medicare beneficiaries the option of obtaining coverage from private insurers. In 2003, the option to obtain prescription drug coverage was included, and the program became known as Medicare Advantage. Rather than being restricted by the guidelines and coverages offered by Medicare Part A and Part B, Medicare Advantage allows beneficiaries to shop around in the private insurance market to find coverage that meets their specific needs.

Scope of Coverage

• While Medicare Advantage plans offer more choice, they still are required to provide all basic Medicare Part A and Part B benefits, with the exception of hospice care which is still covered under the original Medicare. Advantage plans must also cover urgent and emergency care needs. Depending on the plan you select, you may also have coverage for things like vision, dental, hearing and health and wellness care, items that are not covered under basic Medicare. Many MA plans also provide prescription drug coverage.

Plan Types

• MA also offers a wider selection of plan types than basic Medicare. Beneficiaries can choose from a range of managed care plans like Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private Fee-for-Service (PFFS) plans. The plans typically require that you join a network of health care providers and may charge an additional fee if you go outside the network. Premiums and coverages can vary widely depending on the insurer you select as well as the type of plan.

Drawbacks

• While Medicare Advantage plans offer more freedom of choice, there are also some potential pitfalls. The need to stay within a provider network may make the cost of seeing a specialist outside the network prohibitive. Because the plans are provided by private insurers, they do not offer the standardization of basic Medicare, which can make it more difficult to understand what you're really buying. MA insurers can and do go out of business, which could leave you scrambling to find coverage elsewhere.