Michael M Insurance Blog

Medicare Part C- Medicare Advantage

Apr 13, 2021 | 0 comments

Medicare Advantage Plans have been around for a while, helping individuals cap their costs associated with Medicare. They are very much what most of us are familiar with: HMO’s, PPO’s PFF’s etc. The most popular plans are HMO’s and PPO’s. Most come with a Part D Rx Plan included, generally don’t have a Health deductible and have Copays/Coinsurance for various services.
A brief description-
HMO- Health Management Organization-     
These have a Network of Doctors and Hospitals. Generally, all care goes through your Primary Care Provider which with a lot of plans requires a Referral and if you go out of network you will pay the full cost of the provider.
PPO- Preferred Provider Organization– These also have a network of Doctors and Hospitals but the key difference is if you stay in network you will pay a lower copay and if you go out you will pay slightly more. Also, you will not need a referral to see a Specialist giving more flexibility when traveling.
Premiums– These plans have Premiums as low as $00.00. You will still have to pay your Part B Premium.
Non Medicare Services Offered By Some Plans-
Hearing Aids
Pharmacy Over-The-Counter Benefits
Cost Cap
Medicare Advantage Plans come with a cost cap. This means, when you reach a certain amount outlay in copays/co-insurance you will stop paying and the plan will continue to provide coverage for the rest of the calendar year. On January 1 the clock resets and the process begins again.
How Much Is The Cap?
That depends upon your area. In some parts of New York, a PPO plan would look something like this-
In Network– Your Max. out of pocked could be $7550
Out Of Network–                                                     $11,300
(Keep in mind that in other areas of the county these amounts could be significantly less)
Seems like a lot but considering your cost share with just Medicare could be in the 100’s of thousands, it’s not too bad.
In other states it could be considerably less.
Medicare Advantage plans are a great choice for those of us that want more coverage than straight Medicare and would like to get some extra goodies.