Each kind of Medicare plan- Original Medicare, Medicare Supplements, Medicare Advantage, Medicare Part D- works a little differently. There are some quirks and characteristics of Advantage plans that you should be familiar with to have a better idea of how this kind of plan will suit you.
Advantage plans are sold privately, which means you won’t find them through Medicare itself. You have to go to a private insurance company such as AARP, Mutual of Omaha, Cigna, Aetna or one of the many other national and local insurance companies that sell them. Each of these insurers has to provide Advantage plans that have basic coverage, but they can add some coverage onto that to make the plans their own and to set them apart. This gives you some options, and we’ll get into the different medical expenses they can cover for you shortly.
Advantage plans will essentially replace your Original Medicare plan, if you indeed have one. If you don’t have Original Medicare, then you can still sign up for the Advantage plan, and it will serve as a substitute for Original Medicare, covering many of the same expenses. It covers the cost of most Medicare Part A and Part B services, which takes care of a lot of the cost of hospital stays, bloodwork, lab tests, blood use, prescription drugs, doctor visits and more. It also covers you for all urgently needed medical services or those categorized as emergency services.
This basic coverage is provided for you no matter which insurance company you buy your Advantage plan from and what kind of Advantage plan you get. Even the price you pay for the plan does not affect the basic coverage. You are guaranteed at least this amount of coverage with Advantage plans.
Advantage plans will all be restricted by their insurer’s network. That network refers to any clinic, doctor office, hospital and even pharmacy that has decided to accept the insurance company’s coverage plans. If you go to any medical facility or pharmacy that is on the network and you receive healthcare services there, then your plan will be valid there and you will receive full coverage. It doesn’t matter what kind of Advantage plan you pick- the full coverage of your plan is always available the network.
But what happens when you go off the network for medical services? How much you are covered for according to your plan will vary based on the kind of network option you chose. There are two basic network options to pick from these are HMOs and PPOs. The one most people will go for is the HMO. This covers you solely on the network. Off the network, it will do nothing for you, except in some emergency situations when you have no choice but to go to an off-network facility for treatment.
PPOs give you better coverage, but they also cost you more. These will cover you full on the network as you might expect, but of you go to a medical facility that is not part of your insurer’s network, and you have a PPO plan, then you will be covered partially. That gives you freedom to go just about anywhere for medical coverage, but you need to bear in the mind the lowered coverage off the network and the higher costs for the PPO plan.