Facts About Medicare Advantage Plans

Medicare Advantage Plans is prescription drug plans offering coverage for prescription drugs purchased by beneficiaries through their private health insurance or through Medicare. The Program is primarily designed to provide beneficiaries with an alternative to long-term care hospitals and physicians’ offices. Many Medicare Advantage Plans is similar to traditional HMOs and PPOs, but some differ in many ways. The common difference between Medicare Advantage Plans and traditional HMOs is that the number of different drugs covered. A Medicare Advantage Plan may cover several dozen different types of drugs. Some even cover hundreds of drugs. Most Advantage Plans have a pool of beneficiaries that make sure that the drugs covered are reasonably priced.

A Medicare Advantage Plan has the same mandate as an HMO or PPO. It must cover at least twelve basic”essential” drugs, as defined by the United States Department of Health and Human Services. Unlike traditional HMOs and PPOs, it doesn’t cover prescriptions for cancer treatments, steroids, blood pressure medication, and sedatives and tranquilizers. Medicare Advantage Plans are managed care plans that perform the same functions as traditional health plans. They manage benefits, provide payment and excellent reporting, and allocate benefits based on beneficiary health status. Medicare Advantage Plans is normally available to people that are age 65 or older and are getting Social Security benefits.

Those interested in Medicare Advantage Plans should discuss the plans with their regular medical care provider first. In addition, beneficiaries must check with their provider to make sure that Medicare Advantage Plans remains available. Most plans are available for many beneficiaries, but not all plans are equally accessible. Because the Medicare program is a guaranteed benefit under the Social Security Act, Medicare Advantage Plans is governed under federal law. Part of the national governing agency, known as the Federal Drug Administration (FDA), enforces Medicare Advantage Plans.

A Medicare Advantage Plan Differs from an HMO or PPO in that Medicare Advantage Plans are not required to offer services at HMO or PPO locations. Medicare Advantage Plans is federally regulated programs; thus, they are subject to the exact rules and regulations as HMOs and PPOs. Medicare Advantage Plans generally allows beneficiaries the choice of accessing health care services in the location where they work or live. A Medicare Advantage Plan has a network of participating hospitals, physicians’ offices, pharmacies, clinics, and other providers. Medicare beneficiaries who choose an Advantage Plan typically have more access to such providers than those who choose traditional HMOs or PPOs.

Deductions are available to those beneficiaries who choose to get a higher deductible. By way of example, if you opt for a $3000 deductible, your provider will be liable for the payment of 100% of your medication price. Medicare Advantage Plans typically covers hospitalization or the prices of prescription drugs if the beneficiary chooses a doctor’s office for treatment. They generally cover outpatient care, surgical procedures, or both. Medicare Advantage Plans was initially created as a solution to the problem of fragmented care for seniors. They work to reduce this problem by connecting patients to the care they need. Since it was introduced in 1997, they have been a significant factor in enhancing the quality of patient care.