Medicare Advantage (Part C)
Medicare Advantage Plans are plans from Private Health insurance companies. They include all the covered services under Original Medicare (Parts A and B), along with extra benefits including dental, vision, hearing, etc.
They are alternatives to Original Medicare and usually include a Prescription Drug plan.
Types of MAPD Plans
1. HMO
2. PPO
Medicare Advantage Plans are plans from Private Health insurance companies. They include all the covered services under Original Medicare (Parts A and B), along with extra benefits including dental, vision, hearing, etc.
They are alternatives to Original Medicare and usually include a Prescription Drug plan.
Types of MAPD Plans
1. HMO
- With this type of plan you generally must get services from doctors in the plan netoork. For example you would not be able to see a doctor if the HMO plan does not contract with that particular provider. The doctors and networks need to be participating with that HMO Plan.
- Exceptions
- Emergency Care
- Urgent Care (out of area)
- Temporary out of area dialysis
2. PPO
- With this type of plan an individual does not need to stay in network with their plan. They may see a doctor that is not contracted/in network with that PPO plan. For example Fred may be able to see Dr. Nancy who is with Optum Network even though Optum is not a participating Network with his PPO plan.
- You will generally pay less for doctors in the PPO network
- You will genera;;y pay more for doctors out of network
- You will not need a referral from your Primary Care Doctor.
- These plans may have a higher monthly premium
