Medicare Part C, Medicare Advantage Plans Must, by Federal law cover all benefits of Original Medicare. These Health plans may offer additional benefits beyond Medicare approved benefits, such as Dental, Vision, Hearing, Over the Counter Products, Flex Cards, Gym Memberships, Reward Programs and Transportation.
Each individual plan will have different cost shares, cover different prescriptions drugs and may find your medications on different Tier levels depending on the particular plan you're enrolled on. There are plans that have prescription drug coverage and do not have prescription drug coverage. Keep in mind, if you choose a plan that does not have Prescription drug coverage at least as good as Medicare's you will be imposed with a penalty.
Health Plans may have deductibles on health care, as well as a prescription drugs. They also must include a maximum out of pocket, which limits how much you will spend on Medicare approved health care in a given year.
There are 4 main types of Medicare Advantage Plans:
HMO: Health Maintenace Organization- This is the most popular out of the Part C plans. They typically provide more benefits than the other types of Advantage plans and will usually have the lowest copays. You will have to stay within a network of doctors; however, most plans provide worldwide emergency and urgent care.
PPO: Preferred Provider Organization- This is the second most popular Part C plan, with this plan you will have a network of providers, but you will have the flexibility to go outside your network as long as the doctor accepts the plan. The down side of going out of the network is you will pay more. It is usually about 40% of the cost share, but this varies by plan.
SNP: Special Needs Plan- These plans could be an HMO or PPO; they are designed for individuals with certain illnesses and for people with both Medicare and Medicaid (known as Dual Eligible).
PFFS: Private Fee for Service- These plans will have a network of doctors, but also allow you to see any Medicare doctor that will agree to accept the terms and conditions of the plan, each and every time you see the out of network provider. This is called being deemed. The downside is the provider has the right to accept you or not accept at any given time if they are not in the plans network of Providers.