Things You Should Know About Medicare Advantage Plans

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Navigating through medicare can be tough. There are so many questions people have. Here are things You Should Know About Medicare Advantage Plans


Things You Should Know About Medicare Advantage Plans


When it comes to choosing a Medicare plan for your retirement, considering each option before you finalize helps in getting the healthcare services best suited to your needs. The traditional Medicare plan is sometimes incapable of providing all-in-one healthcare facilities that can be availed using a medicare advantage plan. Here’s all the relevant information you need to know about medical advantage plans which will surely facilitate you in making the right choice.

What is a Medicare Advantage Plan?

On one hand, conventional medicare contains medicare plan parts A and B to pay for hospital and outpatient services respectively. On the other hand, medicare advantage plans offer plans A, B, and an additional plan that covers the costs of prescription drugs used for your treatment. Here are some key takeaways:


  • You can set a cap on the amount you pay for your Medicare advantage plan.
  • MA plans provide additional benefits when compared to traditional plans.
  • Several types determine the coverage and services you can avail of.
  • These plans have low premiums.

The Covered Services

 In addition to the services provided for medical conditions and diseases, MA plans also offer coverage to improve health and well-being. Some important services covered are listed below:


  • Vision and dental problems.
  • Option to join fitness programs.
  • Covering transportation chargers for hospital visits.
  • Taking care of over-the-counter drug purchases.


Moreover, If you face a serious health condition or are chronically ill, the best way is to negotiate and avail a plan that specifically addresses your healthcare requirements. As these plans are usually offered by insurance providers, discussing the plan beforehand ensures you get the most benefits out of your selected plan.

Understanding Costs of MA Plans

The costs of each medicare advantage plan vary depending on the services you avail of. Additional services, unless there is an emergency, can also result in you paying up more than expected. For this reason, you might hear one says Medicare Advantage is not for everyone to choose as their retirement medicare plan. In medicare advantage plans, there is always a maximum limit set for out-of-pocket expenses that are covered when the yearly limit exceeds. Anything within the plan’s network of healthcare providers is almost covered unless you opt for a specialist or doctor that is not included in the coverage area.

Types of Medicare Advantage Plans

There are several types you can pick, depending on your needs. Let’s look into the four types to be clear while choosing one.

1.   PPO Medicare Advantage Plans

This advantage plan offers you to avail services of a hospital, primary healthcare doctor, or a specialist for the management of your disease. If required, you also have the choice to pick these services outside your plan coverage area. However, the expected costs can be higher when compared to the cost of services available within the coverage. In case you might be wondering, prescription drugs are also covered in the plan. 

2.   HMO Advantage Plans

The health maintenance organization plans cover a specific set of services within the plan’s network. In this plan, you have to choose and switch from your primary care doctor to a specialist after a recommendation from your current doctor. Still, emergency care in life-threatening situations is allowed but if it’s not an emergency, you might end up paying unexpected out-of-pocket costs.

3.   PFFS Advantage Plans

A private fee-for-service plan is offered by insurance providers allowing you to get your treatment from doctors, specialists, or hospitals that agree to provide services. Fortunately, in case of an emergency, medical bills are covered under this plan regardless of whether your plan is accepted or rejected by the hospital.

4.   SNPs Advantage Plans

This plan is specifically made to provide services to people with special healthcare needs or who are financially weak to afford medicare services. SPNS plans are also a good choice for individuals with chronic diseases. Virtually every major chronic disease is covered in the SNPs plan. Some notables include cancer, auto-immune disorders, diabetes, heart anomalies, end-stage diseases, stroke, and neurological disorders. Moreover, the elderly who require home care services or live in nursing homes are eligible to apply.

Drug Coverage

Most plans include prescription and over-the-counter drug costs. Yet, several PFFS plans and medical savings account plans don’t offer drug coverage. Drug coverage programs can also be joined separately if your current plan is unable to cover medical bills.


If you are unsure of what to choose, seeking advice from a licensed medicare expert can significantly help you move in the right direction. Planning out every step for your retirement is necessary as it ensures you make the best choices for your life ahead.   

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