Medicare

Part C - Medicare Advantage

As previously mentioned, Part C of Medicare is also known as Medicare Advantage. It is a offered by Medicare-approved third party insurance companies, and is an alternative way to receive healthcare benefits. It combines Part A and Part B and often includes extra benefits including some prescription drug coverage. Some extra benefits that are included in Medicare Advantage plans aren't found under Original Medicare.

Types of Plans

There are different types of Medicare Advantage plans that have unique characteristics. These plans vary and individuals are likely to be better suited for some plans over others based on their personal needs and preferences.

Health Maintenance Organizations (HMOs)

In general, HMOs are cost-efficient plans, but come with a few drawbacks. One drawback of an HMO is the limited network of providers. You are usually limited to providers that are in your plan's network, and seeing out-of-network doctors can come at high out-of-pocket costs.

Some HMOs are known as HMOPOS, or HMO Point-of-Service. These plans may offer partial coverage for out-of-network providers, but you will likely have a higher copayment or coinsurance.

Primary Care Physician: with a HMO, oftentimes you are required to pick a primary care doctor. In addition, you will need to receive a referral in order to see a specialist.

Preferred Provider Organization (PPO) Plan

A PPO plan is a type of plan that has a much broader provider network, allowing you more flexibility with who you can see. With a PPO, you can usually go to out of network providers for covered services, you will likely just have to pay more than you would for in-network care.

Primary Care Physician: unlike an HMO, you do not need to choose a primary care physician and you do not need to have a referral in order to see a specialist. This gives you more options and flexibility when finding care.

Special Needs Plan (SNP)

Another type of Medicare Advantage plan is a Special Needs Plan, or an SNP. These kinds of plans are are more focused to help people who have chronic health conditions or circumstances, like diabetes or a heart condition. Some plans require you to choose a primary care physician and receive a referral for a specialist while other plans do not.

Types of SNP's

Chronic Condition SNP (C-SNP): these plans are for individuals with serious chronic health issues such as diabetes, chronic lung disorders, and heart failure. These plans provide coverage and choices that are specific to treating these conditions.

Dual-Eligible SNP (D-SNP): these plans are for individuals who are eligible for both Medicare and Medicaid. These plans help eligible individuals ensure they receive the best coverage options available from both programs.

Institutional SNP (I-SNP): these plans are specially designed for people who are living in institutions like a nursing home, or if they receive nursing care at a home. These plans are designed to meet the needs of individuals living in these unique circumstances.