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When most seniors turn 65, they become eligible for Medicare. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance) coverage. Also called Part C or MA Plans, Medicare Advantage plans are a different way of obtaining access to this coverage. Seniors can sign up for Medicare Advantage plans through Medicare-approved private companies that must follow rules set by Medicare. (Annual Enrollment Period starts this week!)
When seniors choose Medicare Advantage insurance, they receive both Part A and Part B coverage through their MA Plan. Part A is free to most seniors while Part B comes with a monthly premium. When a Medicare Advantage plan is chosen, Medicare pays a set monthly amount toward their care.
PBC is proud to represent more Medicare Advantage plans than anyone else in Hawaii because it allows us to truly provide unbiased Medicare advice. If you have any questions about your Original Medicare or Medicare Advantage options – including supplemental plans; we are here to help!
The most common types of Medicare Advantage Plans
Medicare Advantage plans are offered by a variety of private health insurance companies and are available through the Medicare agencies that represent them. According to Medicare.gov, these are the most common types of Medicare Advantage plans:
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNPs)
Some of the less common Medicare Advantage plans include:
HMO Point of Service (HMOPOS) Plans
Medicare Medical Savings Account (MSA) Plan
What are some of the differences between Original Medicare and Medicare Advantage?
There are several differences between Original Medicare and Medicare Advantage plans. Here are some to consider:
Most MA Plans include prescription drug coverage while Original Medicare does not. Many seniors who choose Original Medicare add on a Part D plan to get prescription drug coverage.
Most MA Plans include additional health services such as vision, hearing and dental services while Original Medicare does not.
Some MA Plans offer additional services like transportation to doctors’ visits, fitness and wellness programs, and over-the-counter drugs. Original Medicare is not designed to cover these kinds of “extra” services.
MA Plans can be tailored to meet the needs of certain chronically-ill enrollees. *
MA Plans set a limit on annual out-of-pocket expenses to help protect seniors from unexpected costs, while Original Medicare does not. Note that some seniors with Original Medicare add on a Medigap plan to cover many of the out-of-pocket expenses they would otherwise incur.
With many MA Plans, seniors will need to receive services from in-network health care providers to ensure the lowest costs and some plans won’t cover services from providers outside the plan’s network and service area. Original Medicare can be accessed at standard Medicare rates through any participating health care provider across the U.S.
*Chronically-ill individuals can benefit greatly from the services of a Medicare agency to discuss their options.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.