More than 27 million adults and people with disabilities rely upon health insurance through Medicare Advantage plans. Medicare Advantage delivers improved services, improved care, better value, and higher levels of satisfaction to the members of the plan.
Several different types of Medicare Advantage plans are available. Most fall into one of the following categories:
Health Maintenance Organization (HMO) Plans: In a Medicare Advantage HMO plan, the beneficiary must receive all services and medical care from providers who are involved in the plan’s network. However, this restriction does not apply to emergency care, out-of-area urgent care, and out-of-area dialysis.
Preferred Provider Organization (PPO) Plans: In a Medicare Advantage PPO plan, the beneficiary relies upon doctors, health care providers, and hospitals involved in a network. A beneficiary using the preferred providers will have to pay less in co-payments. A beneficiary, if he or she prefers, may still consult with a doctor or get the health care services outside the network, however this may result in higher cost.
Private Fee for Service (PFFS) Plans: In a PFFS Medicare Advantage plan, a private insurance company provides the beneficiary with all benefits the beneficiary would have received under Original Medicare Parts A and B, together with any other benefits which the insurance company wishes to provide under the plan. A PFFS plan does not restrict the beneficiary’s choice to specific providers. The beneficiary may use any provider willing to accept the plan’s financial terms and conditions.
Special Needs Plans (SNPs): A Medicare Advantage SNP is a plan similar to HMO or PPO plans. However, Medicare Special Needs Plans offer limited membership to individuals suffering from a particular disease or having a particular disability. In Special Needs Plans, the members have benefits, drug formularies, and provider choices designed to meet all the particular needs of the specific group or condition treated. Some SNP’s will cover out-of-network services and providers, while others won’t
The issue of coverage is particularly important with SNP’s, as, by definition, beneficiaries have special, often difficult, needs that rely heavily upon consultation with specialists. Before selecting a particular SNP, the beneficiary must determine in advance that his or her preferred specialist participates in the network.
In choosing a particular Medicare Advantage plan, a beneficiary should be aware of the goals and design of the program when it was founded:
Medicare
Minimizing cost for the taxpayers: Medicare Advantage plans were designed to minimize costs for the taxpayer, while still providing good service for beneficiaries. Cost savings are realized by paying private insurance companies a lump-sum per enrollee in PPO or HMO-like plans. At the same time, beneficiaries can receive a better mix of benefits tailored to their individual needs, and more responsive service than under Original Medicare.
The most important benefit received through Medicare Advantage plans is usually prescription drug coverage through what is usually referred to as “Medicare Part D.” Medicare beneficiaries not receiving prescription drug coverage through other plans can enroll in several different Pennsylvania Medicare Part D Plans.
Providing Improved financial security: Medicare Advantage plans provide improved financial security for beneficiaries. In the year 2021, the average monthly premium for Medicare Advantage plans was estimated to be around $21.00. This statistic shows a decrease of 34% since the year 2017.
Approximately 40% of Medicare Advantage plan beneficiaries are on a fixed income. Any decline in premiums or other reduction of charges helps those on fixed incomes to have easier access to economical and stable health care, leaving more money for other expenses. If you want to get the most efficient health care benefits, you should seek advice from an established and reputableMedicare Insurance Agency which can also help you find the most cost-efficient Medicare Advantage plan that is right for you.
Promoting Health care services and peace of mind: As the COVID-19 pandemic spread across America, Medicare Advantage plans acted quickly to provide beneficiaries with essential services designed to meet the crisis. Plans offered coverage for such services as diagnostic testing, medical treatment, COVID-19 vaccination, telehealth consultation, and other insured medical services. Medicare Advantage plans worked to keep American seniors and people with disabilities healthier, with efficient delivery of high-quality medical service.
Delivering improved services: Medicare Advantage plans currently have more than 27 million Americans enrolled. More and more people select Medicare Advantage plans for improved benefits, better administration, better health and chronic disease management, as well as expanded benefits such as in-home support services, wellness programs, vision, hearing and dental benefits, transportation and meal delivery benefits, and companion care. In summary, Medicare Advantage plans offer better care for better value.
Economical plans: The average beneficiary covered by a Medicare Advantage plan pays no more than a beneficiary enrolled under the Original Medicare program. Medicare Advantage plans are able to offer more benefits and better value as Americans receive more coverage for less cost.
Overwhelming support for Medicare Advantage: Medicare Advantage programs enjoy overwhelming customer satisfaction and support. It is estimated that more than 94% of the beneficiaries of Medicare Advantage plans are satisfied with their coverage. Given this overwhelming response, Medicare Advantage plans have gained strong bipartisan political support.
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