Medicare Advantage, or Medicare Part C, is a bundled alternative to Original Medicare. Medicare Advantage is offered by Medicare-approved private companies that agree to follow the rules set by Medicare. These plans often include prescription drug coverage and, depending on the plan, may also include vision, hearing, dental, and/or coverage for fitness programs.
These plans set a limit on your out-of-pocket costs each year for covered services to protect you financially. Most plans require you to use medical providers who are in-network for the plan, although some plans offer out-of-network coverage at a higher cost.
There are six different types of Medicare Advantage plans:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSA) Plans
Does Medicare Advantage Limit Out-Of-Network Care?
The short answer is: it depends on the Medicare Advantage plan that you have. Generally, Health Maintenance Organization (HMO) plans are the most strict with in-network versus out-of-network care. But, another more popular Medicare Advantage plan is the PPO plan.
PPO plans have in-network providers you can use and allow you to go out-of-network to get your care. Just keep in mind that you will pay less when you use in-network providers.
SNPs also require you to use their in-network providers, but this is because their plans are tailored to meet your specific needs. This includes providers who can provide you with the care/treatment you need.
How Can I Understand My Medicare Advantage Plan’s Network?
To understand your Medicare Advantage plan’s network, ask your plan the following questions:
- Are my providers in the plan’s network?
- What will I pay for services out-of-network?
- What happens if I need covered treatments that aren’t available from a provider in the plan’s network?
- What will happen if my provider no longer participates in the network?
Trying to Decide if Medicare Advantage is Right For You?
Simple Retirement Benefits can help. We’re experienced, trusted Medicare advisors who can help you make informed choices about one of the most important decisions of retirement: your Medicare coverage. Reach out to us today at 512-432-5414 for your free quote.
