Medicare Advantage Plans (PPO, HMO and PFFS)

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What are Medicare Advantage Health Plans?

Medicare Advantage health plans provide different ways to get your health care coverage in the Medicare program. The Medicare Advantage health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality.

Medicare Advantage (formerly Medicare + Choice) Plans are available in many areas. If you have one of these plans, you don't need a Medigap policy.

If you decide to join a Medicare Advantage Plan, then you will use the health care card that you get from your Medicare Advantage Plan (provider) for your health care. These plans often give you more choices and, sometimes, extra benefits, like extra days in the hospital.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium of $88.50 in 2006 to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

If you're in a Medicare Advantage Plan, you don't need a Medigap policy because Medicare Advantage Plans generally cover many of the same benefits that a Medigap policy would cover, like extra days in the hospital after you used the number of days that Medicare pays for.

Medicare Advantage Plans (PPO HMO and PFFS) are now available in many parts of Washington. These are the Medicare HMO and PPO Plans which have co-payments for Doctors office visits and Hospitals. Unless you are in Final Stage Renal Failure, these plans are "Guaranteed Issue". We like to remind people that these are "managed care plans", and that Medicare is no longer your primary insurance, the HMO is. So if you do not follow the rules of the plan…you do not have coverage.