Medicare Advantage (Part C)

Medicare Part C, formerly known as “Medicare+Choice,” is now known as “Medicare Advantage.” If you are entitled to Medicare Part A and enrolled in Part B, you are eligible to switch to a Medicare Advantage plan, provided you reside in the plan’s service area. Medicare Advantage provides the following options:

• Coordinated Care Plans (the Balanced Budget Act of 1997’s umbrella term for managed care plans);
  • HMO plans, otherwise known as Health Maintenance Organization plans, emphasize preventive care but without coverage for providers or facilities outside the HMO network. They almost always require a network primary care physician referral to access a network specialist; they usually offer drug benefits.
  • POS plans, otherwise known as Point of Service Plans, offer a network of preferred providers, like HMO plans, but also provide reduced benefits for providers or facilities outside the HMO network. They typically require a referral from a network primary care physician to access a network specialist; they sometimes offer drug benefits.
  • Regionally Expanded Preferred Provider Organization (PPO) plans are similar to POS plans but have broader geographic access to network providers in a larger service area, and with reduced benefits outside the PPO network. They do not typically require a referral from a network primary care physician to access network specialists. They may or may not offer drug benefits.
  • PSO plans, otherwise known as Provider-Sponsored Organizations, are similar to the POS plans but are usually organized with physicians that practice in a regional or community hospital. There may or may not be coverage for providers or facilities outside the PSO network, depending upon the plan designs offered. They may require a referral from a network primary care physician to access network specialists. They typically offer drug benefits.

• Medical Savings Accounts set up in conjunction with private fee-for-service plans providing:
  • at least the same benefit coverage levels as Medicare Parts A and B; or
  • high deductible coverage.

Call 1-800-MEDICARE or visit http://www.medicare.gov/ to determine if your plan choices have improved in your area.

NEA Member Benefits believes that the more traditional coverage offered by Medicare combined with a Medicare supplement insurance plan is still the choice that gives you the most freedom.  It lets you choose your doctors and hospitals and helps you control your out-of-pocket costs. It lets you remain in control of the management of your care. While some of the other options may appear a little cheaper up front, they can limit your medical care choices and could hit your pocketbook hard if you get seriously ill.

For more information, visit our new Consumer Guide on Medicare and Medicare supplement insurance.