Instead of choosing Original Medicare, you may elect to get their Medicare benefits through a Medicare Advantage plan (Medicare Part C). You must have both Medicare Part A & Part B to join such a plan. Medicare Advantage plans use a limited network of health care providers and facilities and a system of “prior approval” from a primary care physician, sometimes referred to as a “gatekeeper.” Most plans allow you to select a primary care doctor from those that are part of the plan. Generally, the doctor authorizes, arranges for, and coordinates your care, and decides what care is reasonable and necessary.
You must continue to pay the Part B premium and you may have a premium for the Medicare Advantage Plan as well. These plans require co-payments most times that you go to the doctor or use other services. You must get all of your Medicare hospital and medical benefits through the plan. You retain all your Medicare protections and appeal rights.The types of Medicare Advantage plans available in Maine:
- Health Maintenance Organization (HMOs)
- Preferred Provider Organization (PPOs)
- Private Fee for Service Plans (PFFSs)
- Medicare Savings Plans
- Special Needs Plans (SNPs, designed primarily for people in acute-care rest homes)
Each of these variations has pluses and minuses—the main distinction among them is how easy (or difficult) it is to see a non-network doctor or specialist. Generally, HMOs are the strictest and the others are more flexible…but have higher monthly premiums.
The most important consumer tip when considering a Part C plan: make sure your medical providers and hospitals are in the plan’s network before you join.
Also note: You must get all of your Medicare benefits through your MA plan. You may not use Original Medicare.