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Understanding Medicare Advantage Plans
Get the facts
When choosing this or any other health insurance option, you should learn as much as possible about the plan before you make a commitment. The importance of this advice was proven recently in relation to some Medicare Advantage private fee-for-service plans. A Medicare Advantage Plan is designed to make it possible to extend your coverage beyond the basic Medicare programs. These plans, which are sometimes referred to as “Medicare Part C,” are typically similar to a PPO or HMO and can combine hospital, medical and prescription drug coverage in one plan that is available through private insurers approved by Medicare.
Problems discovered
While Medicare Advantage plans can be an excellent choice in some circumstances, Congress and many states have investigated abusive sales tactics employed by marketers selling private fee-for-service Medicare Advantage plans. According to the Center for Medicare Advocacy, those enrolled in the plans have sometimes faced difficulties in finding doctors who would treat them. There have also been instances when a private pay-for-service plan offered no more than traditional Medicare but did charge a higher fee. These plans are also exempt from many of the regulations that apply to other types of Medicare Advantage plans.
Know what to ask
One of your questions about any plan should be which doctors will accept this insurance, since some doctors won’t accept patients from private Medicare plans. You’ll want to know, too, whether you can see doctors or use hospitals outside the plan’s network. Ask also about each plan’s premiums, coinsurance and deductible to make sure they are affordable and compare well with your other options, including the original Medicare plan. Find out if the plan provides added benefits beyond what you would get using the basic Medicare plan, such as prescription drug coverage. When you have a Medicare Advantage plan you usually don’t need Medigap insurance, so confirm that this is the case when you sign up.
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