Medicare Advantage Plans had their start in the 1970’s as “demonstration plans” that allowed recipients to get their Medicare benefits through a managed care program rather than the traditional FFS (Fee For Service) system of original Medicare. In 1997 it was given the name of Medicare+Choice and then in 2003 was re-named to Medicare Advantage. Over the years the basic way the plans operate have not changed much.
Medicare Advantage Plans come either with Drug coverage (MAPD) or without (MA). Each plan must be approved by the federal government to provide “equivalent” coverage to original Medicare. Equivalent does not mean, however, exactly the same.
Many MA and MAPD plans are HMO type plans where you must choose a Primary Care Provider (PCP) and in order to see a specialist for any condition you must first obtain a referral from your PCP. Additionally, those specialists must usually be in the HMO network as well. Out of network coverage is covered either at a higher cost to you, or not covered at all in some cases.
There are some of the Medicare Advantage Plans that are PPO (Preferred Provider Organization) plans. These operate in a very similar manner to individual and small group insurance policies for people under 65. The lowest cost is obtained by visiting in-network providers but out-of-network providers are covered as well although at a higher out of pocket cost.
When shopping for Medicare Advantage Plans, it is important that you are comfortable with either the HMO or PPO network and restrictions, plus you will want to see what the cost is for any prescription drugs you many take on a regular basis.
This year in Bonner County, there are several options for people to choose from. For Medicare Advantage Plans with Drug Coverage, Blue Cross is offering three plans, Regence is offering two, Humana and PacificSource are each offering one plan. In addition, Blue Cross and PacificSource are each offering a plan without drug coverage (MA).
These plans vary in coverage and price and it is important for you to compare the plans before making a decision on any one feature such as premium. You can contact me by phone or Contact Form for an appointment, or you can compare plans at the official website, Medicare.gov. Also, be sure to check out shopping tips on the How to Shop page.