What Is Medicare Advantage Insurance?

Medicare Advantage Insurance is a program that was created with the Balanced Budget Act of 1997 or BBA. The law was signed into law on Aug. 5, 1997, and split the Medicare program into multiple parts. The new Medicare Part C that was created by the law eventually became known as Medicare Advantage. Medicare Advantage provides expanded options for individuals who receive coverage provided by Medicare through private health insurance plans.

Available Plans

Medicare advantage comes with many program options which can be used by individuals to receive Medicare covered services. One type of plan is known as a Coordinated Care Plan, which is a managed care plan that includes a health maintenance organization or HMO and a preferred provider organization or PPO. Another type of plan is referred to a private fee-for-service plan, which has specific requirements. Two of these requirements include reimbursing providers on a fee-for-service basis and not putting a doctor or other provider in financial risk.

Coverage Scope

Medicare Advantage plans are required to provide coverage for services that are currently provided by Medicare Part A and Part B. Plans are also required to provide information to enrolled individuals about hospice care availability and if a hospice care facility is within their service area. Supplemental benefits may be offered by these plans that can charge a separate premium. However, the premium must be the same for all individuals within a plan and can't be excessive.

Enrollment

Each year, the Centers for Medicare and Medicaid Services provides a coordinated election period in which individuals who belong to Medicare can choose between original Medicare and a Medicare Advantage Plan. Individuals who do not make a selection during the enrollment period will maintain coverage provided by original Medicare. Individuals who have health issues or other conditions cannot be denied enrollment by a Medicare Advantage plan.

Eligibility

Medicare Advantage plans have certain eligibility requirements that need to be met in order to enroll in a health plan. Individuals must be currently enrolled in Medicare Part B and have benefits available by Medicare Part A. Individuals who are eligible can select a Medicare Advantage plan if one is available that services their geographic area. Individuals that are ineligible for Medicare Advantage plans include federal employees receiving health benefits, with excpetions.

Guidelines

Individuals considering a Medicare Advantage plan should follow guidelines in order to make an informed decision and avoid problems later. One guideline includes looking at the literature provided by each plan. Another guideline includes seeing if the health plan includes coverage or Part D, prescription coverage. Individuals should also know how complaints and questions are handled by the health plan.

References

• Medicare Advantage Plans
• Medicare Advantage