How to Compare Medicare Advantage Choices

Medicare Advantage is now offered, to expand benefits and cover gaps in the system, through private health insurance programs like HMO's and PPO's that have made contracts with Medicare. If Medicare Advantage looks like a maze to you, this article can help to clear some of the fog away.

Difficulty: Moderately Challenging

Instructions

1. Look into the Medicare Advantage Private Fee for Service Plans (PFFS). You can choose any doctor who accepts Medicare payments. It's different from other plans in that there is no Primary Care Physician is required and no referrals are needed to see specialists. The cost for the premium varies by co-payment.

2. Investigate the Medicare Advantage HMO's, also known as Managed Care Plans, which have an emphasis on prevention and wellness. They're offered through private insurance companies and include a network of doctors and hospitals. Co-payments are required each time a service is used, a primary care physician is required and a referral is needed to see specialists.

3. Inquire about a Medicare Advantage Preferred Provider Organization Plans/ Regional PPO's. PPO benefits differ according to the plan you chose. There are no referrals needed to see specialists and no primary care physician is required. There is some payment for out of network physicians.

4. Consider a Medicare Advantage Medical Savings Account (MSA) and high deductible insurance. The annual contribution to the account is made by Medicare into an interest-bearing account to defray Medicare-qualified health care costs. The MSA pays the allowable costs that aren't paid, due to the deductible.

5. Know if you need a Medicare Advantage Special Needs Plans. This plan covers care management for people with multiple diseases, chronic illnesses that require special care and focused care management. The plan tends to be limited to people in institutions like nursing homes, and people who are eligible for both Medicare and Medicaid or that have certain chronic disabling diseases.

Tips & Warnings

• The money that was put into the MSA account belongs to you. It can be rolled over to the next year and accumulated on a tax free basis, used to pay co-pays or rolled to a beneficiary if you die.
• All plans contain the basics of Medicare part A & B.
• Co-payments can become costly depending on health and the plan.
• It may be difficult, if not impossible, to get payment for out of network physicians if you're using an HMO.