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Medicare Advantage
Medicare Advantage, also known as Medicare Part C, is a health insurance plan provided by private companies approved by Medicare. It offers at least the same coverage as Original Medicare – Part A and Part B. But also, Medicare Advantage gives some additional benefits that Original Medicare does not provide.
Health Maintenance Organization (HMO)
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An HMO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except for emergency care, out of area urgent care, and temporary out of area dialysis.
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Some HMOs are Point-of-Service (HMO-POS) plans that may allow you to get some services out-of-network for a higher copayment or coinsurance. It’s important that you follow the plan’s rules, like getting prior approval for a certain service when the plan requires it.
Preferred Provider Organization (PPO)
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A PPO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals
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You pay less if you go to providers and facilities that are belong to the plan's
network.
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You can generally go to out‑of‑network providers for covered services, but you’ll usually pay more.
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Private Fee-for-Service (PFFS)
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A PFFS is a type of Medicare Advantage Plan. PFFS plans aren’t the same as Original Medicare or Medigap. 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 (SNP)
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A Special Needs Plan (SNP) provides benefits and services to people with specific conditions, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
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SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.
Extra Benefits
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There are a few extra benefits that Medicare Part C can cover, but Original Medicare does not. Some of these services that Medicare Advantage may include as extra benefits are: Routine dental, vision, and hearing care, fitness benefits such as exercise class , emergency medical assistance while traveling outside the U.S., and allowance to buy health care products.
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These additional benefits can sometimes be provided at no additional cost to you. This is possible because Medicare actually pays the insurance company a set amount for providing your healthcare coverage.
Medicare Supplements
Medicare Supplements, also known as Medigap plans, are sold by private insurance companies to help you cover the out-of-pocket costs left behind by Medicare. Think of them as a secondary insurance plan, with Original Medicare (Parts A and B) acting as your primary insurance.
When you have a Medicare Supplement plan, Original Medicare pays on your medical claims first, up to the limits set by those benefits. Then, your Medicare Supplement plan kicks in and pays for some or all of what’s left. The amount it picks up will depend on which Medicare Supplement you have.
Medicare Part D
Medicare Part D is a federal prescription drug plan program administered through private insurance companies. Medicare beneficiaries can enroll in a standalone Part D plan to supplement their benefits under Original Medicare, or they can choose to enroll in a Medicare Advantage (Part C) plan that includes prescription drug coverage.
Original Medicare (Parts A and B) does not include coverage for prescriptions that you’d usually get at your local pharmacy. Part D plans require a separate monthly premium and have their own deductibles, copayments, and coinsurance costs.
Health Insurance
The ACA (affordable care act), was signed into law during President Obama’s term in 2010. This is why so many people also refer to these plans as Obamacare. The goal of the ACA was to improve the accessibility, affordability, and quality of health insurance across the country. ACA plans are sold on the Marketplace or Exchange. Individuals and families can enroll in an ACA plan rather than an employer-sponsored or private plan. Pre-existing conditions won’t prevent you from enrolling in an ACA plan. In addition, many people receive tax credits and subsidies to reduce their premiums.