A Medicare Advantage plan is a way for a Medicare beneficiary to have their Medicare services covered by a Private Insurance Company. These plans must first be approved by CMS (Centers for Medicare and Medicaid Services) in order to sell these plans. CMS performs strict oversight of these private plans.
Medicare Advantage Plans in Georgia are growing in popularity
- Many of them offer a low to non-existent monthly premium. That means many plans have a $0 monthly premium. The insurance carriers can do this because they are subsidized by Medicare to care for Medicare members by covering all the services that Original Medicare offers. Medicare pays the insurance carrier of each Advantage plan a set monthly amount to cover the benefits of Original Medicare, for each beneficiary that enrolls in their plan-whether that member uses any services that month or not.
- The Advantage plan must provide, at a minimum, all the benefits offered by Original Medicare. Part of the appeal of these plans is due in large part because of the additional benefits they offer on top of the required benefits. These additional services are things such as dental, vision and hearing, meals while recovering from a hospital stay, transportation to doctors’ appointments, free over the counter items from a mail order catalog monthly or quarterly, etc.
Types of Medicare Advantage Plans Available in Georgia
Some Medicare Advantage plans have drug coverage included and some have NO drug coverage built in. It is very important for you to understand the difference. To start with let’s discuss these two acronyms:
- MA (Medicare Advantage) These are plans that only cover medical costs related to your Medicare Part A and Part B Medicare coverage. These plans have NO out-patient prescription drug coverage (no Part D coverage included). You must be careful when looking at these plans because in most cased, no stand-alone Part D drug plan can be added to these plans. There are some exceptions for certain types of MA’s, like an MSA plan described further down.
- MAPD (Medicare Advantage Prescription Drug) These plans combine medical coverage (coverage for Parts A and B of Medicare) and DOES Include out-patient prescription drug coverage (Part D coverage) all in one plan. These types of plans are what most people think of when they are referring to an Advantage Plan and are the most common.
There are different types of MA or MAPD plans in Georgia
- HMO plans- With an HMO Advantage plan you MUST use doctors or facilities that are in the plan HMO network or their services will not be covered by your plan, except in a true emergency.
- PPO Plans- With a PPO plan you can use any doctors or facilities that accept Medicare, but you will pay more if they are not also in your Advantage plan’s PPO network. You do have the freedom to use Out of Network providers but remember, it will cost you more money.
- MSA Plans-Medical Savings Account-These plans combine a Medicare Advantage plan with a high-deductible health savings account.
- SNP Plans-Special Needs Plans. These plans are written to address specific needs for people who fit into a specific special need’s category. Most SNP are HMO plans.
* These are 3 types of SNP’s:
- DSNP-Dual Eligible Special Needs Plans -These plans are written specifically for individuals of any age who are eligible for both Medicare and Medicaid. There plans look different based on the different levels of Medicaid coverage, which in turn is based on an individual’s income and asset level.
- CSNP-Chronic Special Needs Plans – These plans are written for people with specific chronic conditions like diabetes, cancer, dementia, stroke or HIV.
- I SNP-Institutional Special Needs Plans-These plans are for people who reside in an institution like a nursing home, long term skilled nursing facility or assisted living facility.