What Medicare Advantage (Part C) Plans are available?

There are several plans available for Medicare Advantage. The Part C plans include the following:

  • Medicare Preferred Provider Organization (PPO) - You are able to see any doctor or specialist that you choose. If they are not in your PPO network, your cost will increase. You usually can see a specialist without a referral.
  • Medicare Health Maintenance Organizations (HMO) - You are able to visit doctors in the HMO network only. In most cases, you will be required to have a referral to visit a specialist.
  • Medicare Private Fee-for-Service (PFFS) - You are able to see any doctor or specialist, but they must be willing to accept the PFFS's fees, terms, and conditions. You do not have to have a referral to see a specialist.
  • Medicare Special Needs - These plans are designed for people with certain chronic diseases or other special health needs. These plans must include Part A, Part B, and Part D coverage.
  • Medicare Medical Savings Account (MSA) - There are two parts to this plan:

  1. A high-deductible plan with which coverage won't begin until the annual deductible is met.
  2. A savings account plan where Medicare deposits money for you to use for health care costs.

Do You Need Prescription Drug Coverage?

Most Part C plans already include prescription drug coverage (Part D). If your plan offers drug coverage, you have to take it. If you have a stand-alone drug plan, and your Medicare Advantage Plan already has one, you will not be able to keep the Part C coverage. If you already have a prescription drug coverage, then you may choose a plan that does not have the drug plan included.

Eligibility for Part C

If you join Part C, you will still be in the Medicare Program and will have complete Part A and B coverage. You will continue to have Medicare rights and protection and in most cases, you will have prescription drug coverage (Part D) included as well.
You can join Part C if you reside in the service area where you wish to join, if you already have Medicare Part A and B, and if you do not have End-Stage Renal Disease (with minor exceptions).

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