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Medicare Advantage plans are privatized health insurance plans available to individuals who have Medicare Parts A & B. 

Under Medicare Advantage Plans, Part A (Hospital), Part B (Medical), & often Part D (Drug) are covered under a private health plan in place of original Medicare. 

These plans often carry lower monthly premiums with higher out of pocket expenses and copays.

Benefits vary by plan and change from year to year but must be approved by the Center for Medicare & Medicaid Services.


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Common Medicare Advantage Plan types:

 Health Maintenance Organization (HMO) 

-Must use contracted network providers except in cases of Emergency care, Out-of-area urgent care, out-of-area dialysis!
Your primary care doctor (PCP) helps you coordinate your healthcare with specialists and referrals. 

HMO Point of Service

In some cases you may be able to go out of network for certain services but costs are lower if you stay in network for those services.

Preferred Provider Organizations (PPO) 
PPO plans have networks of healthcare providers available but you may choose to select a provider out of network at a higher cost and you may see specialists without a referral.

Private Fee For Service


Under this plan type, the plan determines how much it will pay and how much you must pay when you receive healthcare services. Referrals generally aren't required to see specialists but you must make sure your healthcare providers are willing to take your plan prior to receiving services.

Special Needs Plans

These plans are designed for certain populations of individuals who have chronic health conditions (CSNP), are eligible for or are already recieving financial assistance (DSNP), or institutionalized individuals (ISNP).

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