If you’re shopping for medical insurance, you’ve likely heard a little about Medicare Advantage. If you’re not sure how Medicare Advantage differs from regular Medicare — or if you’re interested in comparing Medicare Advantage plans to see which offers the best fit for you — then you’ve come to the right place.
Here’s what you’ll learn from this quick, 10-minute read:
- Medicare’s basic structure
- How Medicare Advantage is different from traditional Medicare
- The different types of Medicare Advantage and what each plan type can offer you
- Resources you can use while comparing Medicare Advantage plans
UNDERSTANDING MEDICARE: THE BASICS
It always pays to begin at the beginning. So, before we dive into the details of comparing Medicare Advantage plans, let’s take a glance at how Medicare is structured, and where Medicare Advantage fits into that.
If you’ve spent a bit of time delving into Medicare, you may have already noticed a repeated reference to various sections of Medicare. These are generally referred to throughout the Medicare website and hardcopy literature as Parts A, B, C, and D.
To demystify these terms:
- Part A refers to coverage relating to a hospital stay. Nursing care, hospice care, and any inpatient hospital visit fall under Medicare Part A.
- Part B of Medicare is likely what you’ll think of immediately when you think of basic, foundational medical insurance. Health professional consultation, long-term preventive care, and diagnostic testing all belong to this section of Medicare.
- Part D is all about prescription drug coverage. For medications to be covered under Medicare, you need to have a plan which includes Part D.
- Part C is an all in one approach to Medicare, generally combining parts A, B, and D, as well as including other benefits, such as vision and dental.
And here is where we get to Medicare Advantage or a Medicare Advantage Plan. Both these terms refer to Part C of Medicare and can be thought of simply as expanded coverage over Original Medicare.
COMPARING MEDICARE ADVANTAGE PLANS
Now that you know what Medicare Advantage is, we can more easily get down to comparing Medicare Advantage plans. It’s important to explain upfront here that there are many individual Medicare Advantage plans, all offering a particular combination of coverage and cost, each with their respective merits for consumers.
To delve into the fine details, you’ll need a comparison tool. More on that later! The most important thing to understand first is that there are two broad types: Medicare Advantage Health Maintenance Organization (HMO) and Medicare Advantage Preferred Provider Organization (PPO).
Medicare Advantage PPO
A Medicare Advantage PPO is bundled Medicare insurance provided by a private insurance company. A PPO is a network of doctors, health care providers, and hospitals. When you seek care through your network of preferred providers, you save money and gain the convenience of accessing administratively compatible providers while retaining the flexibility of seeking care outside your network when required, usually without a referral.
You’ll generally pay a little more to be part of Medicare Advantage PPO, but many customers view the cost as well worth it, given the versatility of this plan type.
Medicare Advantage HMO
This brings us to a Medicare Advantage HMO plan. You’ll pay less for these plans because the plan is a little more rigid and restrictive. Most of your care will come through your HMO network unless you’re facing a medical emergency. Moreover, you likely will require a referral from your primary care physician if you want to see a specialist.
Generally speaking, an HMO plan may make more sense if your health status and lifestyle mean that flexibility is a less pressing concern than budget.
Special Needs Plans
You may also encounter Special Needs Plans (SNPs) within the Medicare Advantage landscape. These plans are heavily customized to the needs of people facing specific health needs arising from a particular disease or health condition. You’ll likely only look closely at these on your doctor’s advice if you have a chronic health condition such as diabetes or chronic obstructive pulmonary disease.
HERE’S WHERE YOU CAN LEARN MORE
If Medicare Advantage PPO, HMO, or a special needs plan sound like a good fit for your medical coverage needs, all that remains is to compare these Medicare Advantage plans in detail. And here’s the good news: This may well be the easiest part of the process, thanks to resources like Anthem’s plan comparison tool.
After entering your details, you gain a concise comparison of Medicare Advantage plans to suit your lifestyle, medical status, and budget. The tool is a great way to tailor a medical insurance plan to only cover precisely what you wish to pay for. It’s the easiest way to get exactly the coverage you need.