What to know about Medicare Advantage coverage in Pennsylvania
Want to know more about Medicare Advantage coverage in Pennsylvania? Then read on to see on to see how Medicare Advantage plans (Medicare Part C) in Pennsylvania work. Medicare Advantage is an alternate way to get your Original Medicare (Part A and Part B) benefits. Medicare-contracted private insurance companies off these Medicare Advantage plans. These plans must give the same level of coverage at minimum that you would get from Original Medicare (Part A and Part B). Medicare Advantage plans have the advantage of adding extra benefits to their plan that is not covered by Original Medicare.
Original Medicare is a government run program that includes Medicare Part A and Part B coverage. This federal program will pay for various medical, skilled nursing facilities, and hospital benefits. However there are lots of benefits that Original Medicare does not cover like:
- Wellness programs
- Hearing
- Dental services
- Routine vision
Also if you want prescription drug coverage you must get it through separate Medicare Prescription Drug Plans. Medicare Part A and Part B does not cover a wide array of prescription drugs.
While Original Medicare will not cover the services above, Medicare Advantage plans will. A Medicare Advantage plan may cover wellness programs, dental care, hearing, routine vision, and even prescription drugs. Also by law, a Medicare Advantage plan must have at least the same level of coverage as Original Medicare.
Where you live will determine the type of Medicare Advantage plan that is available to you. There are several different options that you may choose from. Some of these Medicare Advantage plan options include:
- What is an HMO (Health Maintenance Organization)? An HMO allows members to get their services inside a network of providers. You are not covered from services outside the network unless it is for urgent care or an emergency. With this plan you will have a primary care doctor who handles most of your care. If you need to see a specialist, you must get a referral from your primary care doctor. This type of Medicare Advantage plan is one of the most popular plans.
- What is a PPO (Preferred Provider Organization)? With a PPO plan, you still have a network of providers but it is a more flexible plan. This is because if you use providers outside of the network, the PPO plan will still cover you but you will pay higher cost sharing. If you use the providers inside the plan’s network, then your copayments and coinsurance expenses will be lower. With this plan, a primary care doctor or referrals for specialist care is not required. This plan is also a popular option.
- What is a Special Needs Plan (SNP)? If you qualify a Special Needs Plan then you have to meet certain eligibility requirements. You may qualify if you meet 1 of 3 requirements: have certain chronic illnesses, have Medicare and Medicaid, live in an institution (like a nursing home). These plans can include wellness programs, certain coordination services, and specialized provider networks. Whatever the unique needs of the individual who qualifies for a SNP will get these certain benefits.
- What is a Medical Savings Account (MSA)? This plan is a combination of a medical savings account with a health plan. If you want this plan to cover your medical costs then you need to pay a high annual deductible. You will get a savings account in which the plan will deposit money into. You can use this saved money to cover medical expenses before you’ve paid the annual deductible.
- What is a Private Fee-for-Service Plan (PFFS)? These plans do not have an inside network of providers like a HMO or PPO. You will be able to use any doctor or hospital that accepts the PFFS plan’s terms and conditions. They must accept the terms every time you render a service and they also must agree to treat you.
What to know about Medicare Advantage Prescription Drug plans in Pennsylvania
Prescription drug benefits is an added benefit to some Medicare Advantage plans. You can have a combination of prescription drug and health coverage under one plan called the Medicare Advantage Prescription Drug plan. Review the Medicare Advantage plan that you would like to have and see if it includes prescription drug coverage.
If you need certain prescription drugs, make sure the Medicare Advantage Prescription Drug plan you want has them. These plans vary in terms of what prescription drugs they cover as well as the costs. Review the Medicare Advantage Drug plan’s formulary, which lists out all the prescription drugs covered by the plan. Choose a plan that has your specific prescription drugs. The formularies are subject to change at any time. If it does change, your plan will notify you.
How to Compare and Contrast Medicare Advantage plans in Pennsylvania
Understand what your plan options in your location are before you sign up to a Medicare Advantage plan. The county you live in determines the Medicare plan options you may have and the cost. There are some Medicare Advantage plans that have free monthly premiums. However, please note that even if your monthly premium is free you may have higher cost sharing. Also, understand that you still have to pay your monthly Medicare Part B premium.
Want to find a Medicare plan option that fits your needs? Contact us and a licensed insurance agent will help you get a plan that best fits you.