Medicare Advantage plans (Part C) are an alternative to the federally administered Medicare program. They are administered through private health plans, such as HMOs and PPOs, and have been an option since the 1970s. These private health plans receive payments to provide all medicare covered services to plan enrollees.
Prescription Drug Benefits
Those who enroll in a Medicare Advantage plan can also choose a plan with prescription drug coverage. A Medicare Advantage Prescription Drug plan (MAPD) is a Medicare Advantage plan that includes prescription drug coverage. MAPD plans are offered by private companies that contract with Medicare to provide Part A, Part B and Part D benefits.
The Different Medicare Advantage Plans
In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Special Needs Plans provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.