In general, a Medicare Advantage plan is a health plan option approved by the Centers for Medicare & Medicaid Services (CMS) and operated by a private insurance company. Sometimes, you will hear a Medicare Advantage plan called a “Medicare Part C plan” or a Medicare Health plan.
A Medicare Advantage MAPD (or MA-PD )includes Medicare Part D prescription drug coverage and a Medicare Advantage MA plan does not include drug coverage.
Both MA and MAPD Medicare Advantage plans provide a combination of your Medicare Part A (in-patient or hospital coverage) and Medicare Part B (out-patient or physician coverage) and may also include other “supplemental” service such as limited home healthcare, vision coverage, dental coverage, transportation, and recreational coverage (such as a “Silver Sneakers” membership).
Be Advised:  You may not be able to add Medicare drug coverage to an MA.
If you Enroll in an MA plan (without prescription drug coverage), you may not be allowed to also add a stand-alone Medicare Part D prescription drug plan (PDP).  If you want prescription drug coverage and want to Enroll in a Medicare Advantage plan, then you should choose an MAPD. Only MSAs and PFFS Medicare Advantage plans can add stand-alone Medicare Part D drug coverage (see more below). However, if you receive VA drug coverage, you can Enroll in an MA plan and use your creditable VA drug coverage or you can Enroll in an MAPD plan and use either your VA drug coverage or your MAPD drug coverage (but not both at the same time).
You can read more in our Frequently Asked Question:  “Can I enroll in an HMO and then add prescription drug coverage through a stand-alone Medicare Part D plan?” (Spoiler Alert: No)
You can also read more in our Frequently Asked Question:  “If I have VA drug benefits can I also add Medicare Part D prescription drug coverage?”  (Spoiler Alert: Yes)
A note on Medicare Advantage plans and Healthcare Networks
Most MAs and MAPD have healthcare networks and you may need to visit doctors (or other healthcare providers) who are part of the Medicare Advantage plan network – or be prepared to pay a higher coverage cost.

Types of Medicare Advantage Plans (MA and MAPD)
You can use our Medicare Advantage Plan Finder to browse through the Medicare Advantage plans.  As you review plan in your ZIP Code region, you might notice some common types of Medicare Advantage plans.

• HMO – Health Maintenance Organization plans

  HMOs are wellness-based Medicare Advantage plans and usually have the most-restrictive healthcare provider network, meaning that your healthcare      costs may be higher if you go outside of your plan’s established network. Also, depending on your HMO plan, you may only go outside of your plan      network with a referral from your doctor. Local HMOs are often very affordable compared to other Medicare Advantage plans because the      restrictive network and focus on wellness helps to control healthcare costs. Most Medicare Advantage plans will be HMOs (Health Maintenance      Organizations).

• HMO-POS – Health Maintenance Organizations      Point-of-Service plans

  These Medicare Advantage HMO’s have a more flexible healthcare network allowing you to seek care outside of your plan’s network by paying a higher cost-sharing rate. This type of HMO is often for people who travel part of the year, but still return home for most of their healthcare needs. For instance, you may have a $30 co-payment when you visit a healthcare provider in-network (at home) and pay $60 when you visit a provider outside of the plan’s network (while traveling). Be Advised: Sometimes an HMO POS plans will convert to HMOs (without the POS option) in the following year. Please note, depending on your HMO POS, you may find that out-of-network costs do not apply to your plan’s that your Maximum Out of Pocket (MOOP) limit – check with your plan’s      Member Services for more details.

• PPO – Preferred Provider Organization plans

  Medicare Advantage PPOs have a less-restrictive provider network, but      again, you will pay a higher cost-sharing rate when you visit a healthcare      provider outside of your plan’s network.

• PFFS – Private Fee for Service plans

  Although popular several years ago, fewer Medicare Advantage PFFS plans are now available (for instance, only 33 PFFS plans are available in 2021).  PFFS plans have the most flexible network, meaning that you can go to any health care provider if they accept Medicare and the terms and conditions of your PFFS plan. As noted, PFFS plans are rare, but some people still find PFFS plans as a flexible and economic alternative to other Medicare Advantage plans.

• SNP – Special Needs Plans

  SNPs are Medicare Advantage plans designed for a people with specific      conditions or financial needs. Certain SNPs are available only to      diabetics, people with chronic cardiac conditions, nursing home residents, or people eligible for both Medicare and Medicaid (D-SNPs). If you do not  have the plan’s “special need,” you will not be allowed to Enroll (or stay in) the SNP.

• MSA – Medical Savings Account plans

  MSAs are like Health Savings Accounts (or HSAs), or a high-deductible health plan combined with a spending account that you can use to pay for      your health care costs. MSAs do not provide prescription drug coverage and you would need to Enroll in a separate Medicare Part D plan for your prescription needs. In recent years, MSAs are becoming more widely available across the country.

• MMP – Medicare-Medicaid Plans

  MMP plans were first introduced in 2014 and are only offered in a few locations across the country. As noted by CMS:

“A Medicare-Medicaid Plan (MMP) [like a D-SNP] is a private health plan that has been competitively selected and approved to provide integrated care to eligible full-benefit Medicare-Medicaid enrollees under the CMS Financial Alignment Demonstration.”
(CMS, “Financial Alignment Initiative,” (www.cms.gov/ Medicare-Medicaid-Coordination/ Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/ FinancialModelstoSupportStates EffortsinCareCoordination.html.)

MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply.

AEP is also a great reminder to review your Medicare plan each year so you can make sure you have the coverage you need going forward.

BOOK NOW!

Gr8 MEDICARE SOLUTIONS, 623 Lafayette Ave, Suite 204, Hawthorne, New Jersey 07506, (973)304-4269