Module 2 - Medicare Health Plans: Medicare Advantage Plans Flashcards
Under the Medicare Advantage (MA) program know as Medicare Part C, private companies offer health plans that cover all Medicare Part A and Part B benefits. What else should be known about Medicare Advantage Plans?
– Many also cover Part D prescription drug benbefits (MA_PD plans)
– All Medicare Advantage (MA) plans have a maximum out-of-pocket limit (MOOP) for basic benefits.
– Many MA plans also offer additonal benefits that Medicare does not cover.
– The types of Medicare Advantag (MA) plans are:
-Coordinated Care Plans. These plans have a network of preferred provider and include: (a). Health Maintenance Organizations (HMOs), some have a point-of-service (POS) benefit that allows beneficiaries to go out-of-network subject to limitations. (b). Preferred Provider Organizations (PPOs), which may be local or regional.
– Private Fee-for-Service (PFFS) Plans
– Medical Savings Account (MSA) Plans
Do any Medicare Advantage Plans cover Part D prescription drug benefits?
Yes. Many Medicare Advantage Plans also cover part D prescription drug benefits. The are referred to as MA-PD Plans.
Do Medicare Advantage Plans have maximum out-of-pocket limits (MOOP) for basic benefits?
Yes. All MA plans have a maximum out-of-pocket (MOOP) limit for basic benefits.
What are the three (3) main types of Medicare Advantage Plans?
There are 3 main types of Medicare Advantage plans. They are:
(1) Coordinated Care Plans
(2) Private Fee-for-Service (PFFS) Plans, and
(3) Medical Savings Account (MSA) Plans.
Wht is a Medicare Advantage Coordinated Care Plan?
The Medicare Advantage Coordinated Care Plans Have a network of preferred providers and include:
i. Health Maintenance Organizations (HMOs), some have a point-of-service (POS) benefit that allows beneficiaries to go out-of-network subject to limitations.
ii. Preferred Provider Organizations (PPOs), which may be local or regional
