Understanding the Difference Between Medicare Advantage and Medicare Advantage PPO

Getting information about your Medicare coverage options, getting help from people you trust, and comparing different plans can help you understand all the options available. People with Medicare can get their health coverage through Original Medicare or a Medicare Advantage Plan (also known as a Medicare Private Health Plan or Part C). It is important to consider the key differences between these two options when deciding how you want to receive your Medicare benefits. The table below compares Original Medicare and Medicare Advantage.

With original Medicare, you can access care anywhere in the United States, as long as the provider accepts Medicare. A Medicare Advantage plan may be a better option if you have a maximum outlay that protects you from huge bills. Usually, regular Medicare plus a Medigap insurance plan allows you to have more options where you receive your care. Most plans offer additional benefits that Original Medicare doesn't cover, such as some routine exams and dental, vision and vision services. There is no annual limit to what you pay out of pocket, unless you have supplemental coverage, such as Medicare Supplement Insurance (Medigap).

Check to see if your Medicare prescription drug plan will cover any expensive drugs or equipment (such as supplies for people with diabetes), whether it's standalone or part of a Medicare Advantage plan. People with chronic illnesses and those who develop a serious health condition should further explore the available options.

Medicare advantage plans

cover all of the above (Part A and Part B), and most plans also cover prescription drugs (Part D). Both hmo Medicare Advantage plans and Medicare Advantage PPO plans are offered through the Medicare Advantage program (Medicare Part C). It's important to know the differences in coverage, cost, and provider rules, as they will affect how you decide which option is best for you. Once you've enrolled in Medicare, a key decision point is choosing Part D prescription drug insurance coverage.

Many Medicare Advantage plans include Part D drug insurance, but you can also buy a separate policy for those who choose regular Medicare (Part A and Part B) or a Medicare Advantage plan that doesn't include Part D. The National Quality Assurance Committee (NCQA), an insurance rating organization, also compares what consumers think of the services and doctors of Medicare Advantage plans, and whether the plans meet certain quality standards. While traditional Medicare (Part A and Part B) offers good basic coverage, it only pays about 80% of the costs it approves for hospitals, doctors, and medical procedures. Medicare Advantage plans can save you money, but be sure to check if prescription drug benefits are included. Now that you're planning Medicare, you may have a similar option if you choose to get coverage through Medicare Advantage.

Ask your current doctors if they participate in any Medicare Advantage plans or if they accept regular Medicare. You generally won't have to pay a penalty if you later decide to enroll in a Medicare prescription drug plan and you haven't gone more than 63 straight days without creditable coverage.

Elise Woehl
Elise Woehl

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