The Medicare
advantage plan is provided as an alternative to the original Medicare
plan, depending upon where your loved one lives. Private insurance
companies also provide coverage similar to the Medicare advantage
plan. Frequently they offer broader coverage but limit which doctors,
hospitals, and other health-care providers that your senior may visit
for services.
If your parent or
loved one decides to utilize a Medicare advantage plan, they will
still be in the Medicare program, and will still get coverage included
in Part A. and Part B of the original Medicare plan.
Medicare advantage
plans usually fall under one of the following four categories.
Managed-care.
Under managed-care plans, your senior can only go to doctors and other
providers within the managed-care network. Also, in most cases
referrals to specialists are made through primary care doctors.
Doctors can leave the plan at any time and your senior needs to make
sure that their current doctor is not thinking about leaving the plan
in the future.
Some managed-care
plans offer an option called "point of service" which means that your
senior may go to doctors and hospitals outside of the network, but
they may have to pay deductibles and coinsurance to do so.
Preferred provider
organization.
These organizations are similar to managed-care plans except that your
senior can see specialists without referrals from primary care
doctors. In some cases, your loved ones can see any doctor or other
health care provider who accepts Medicare, although, they may have to
pay an extra charge if the provider is not within the plans
"network".
Private
fee-for-service. These plans operate much like the original Medicare plan except
that are private company, rather than Medicare, determines the
"approved fees", premiums, deductibles, coinsurance, and co-payments.
Your senior may go to any physician or hospital approved by Medicare
who has decided to accept the plan's fees as
their payment.
Specialty plan.
These plans are relatively new in that they provide normal Medicare
coverage, plus they pay for any extra care that is needed because of a
specific disorder or disease (such as renal disease, congestive heart
failure, or diabetes).
In summary,
Medicare Advantage Plans come in many forms with many being very
similar to the original Medicare plan. You should continue to learn
all that you can in order to make sure that your loved one gets the
services that they need through either their original Medicare plan or
through one of these Medicare Advantage Plans.
Some information
from How to Care for Aging Parents by Virginia Morris
Additional
information and web page by Paul Susic M.A. Licensed Psychologist
Ph.D. Candidate Clinical Director-
Senior Care Psychological
Consulting
