Most Medicare beneficiaries are between 65 and 74 years of age.
Once they reach the age of 65, a large number of seniors in the United States begin using Medicare. Medicare is the national health insurance program designed for senior citizens. Medicare was originally made up of only two parts, called A and B, but two more parts have since been added. Original Medicare primarily provides hospital coverage while Part D offers benefits for prescription medications. Part C, more often referred to as Medicare Advantage, is quite different from the other three parts of Medicare.
Benefits
Medicare Advantage policies are required to offer all the same benefits as the original Medicare Parts A and B. These include inpatient and outpatient hospital services, preventive screenings, ambulance transportation and home-health care. One of the biggest draws of Medicare Advantage plans is that they often include other benefits as well. Many MA policies feature prescription drug coverage, which means members do not have to buy a stand-alone plan or enroll separately in Medicare Part D. They may also include hearing, dental or vision coverage as well.
Types of Plans
Unlike original Medicare, Medicare Advantage comes in several different kinds of plans. You can purchase it in a traditional private fee-for-service policy, or you can buy it as a special needs plan tailored to your health condition, an HMO plan, a PPO or even one that works with a medical savings account. Not all companies that sell MA offer all types of plans, however. In addition, Medicare Advantage is sold by service area, so even if your insurance company sells the plan you want, it may not be available in your city or county.
Sellers
Original Medicare comes straight from the federal government. Medicare Advantage is sold only by private insurance companies. The vendors that sell Medicare Advantage must be approved by the Centers for Medicare and Medicaid Services and follow the government's guidelines, but they are allowed to set their own rules in some areas. Beneficiaries still retain their Medicare rights, including the right to appeal decisions, if they purchase Medicare Advantage. But they must also follow policy regulations in order to receive benefits, such as getting a referral to see a specialist or receive services outside the plan's network.
Costs
The companies that sell MA are allowed to decide their own out-of-pocket costs, such as premiums, deductibles, copayments and coinsurance costs, so your MA costs are decided by which plan you buy and from whom you buy it. Your costs will also depend on the type of plan you buy. If you buy a PPO plan, you will usually pay one copay amount if you stay inside the network and another if you go outside the network. As of 2011, all types of Medicare Advantage plans are required to have an annual out-of-pocket limit, which sets the maximum amount you will have to pay per year. In 2011, the maximum annual out-of-pocket expense was capped at $6,700, but MA vendors can choose to set their out-of-pocket limit lower.
Tags: Medicare Advantage, that sell, Advantage plans, Advantage sold, annual out-of-pocket
