It is a fact that, every week about tens of thousands of Americans attain the age of 65. This is increasing the population of people needing safe and reliable health care. US Government found a better way to ensure the health of their older citizens by introducing a national health insurance scheme. Since it was introduced in 1966, this scheme has gone through a lot of metamorphoses. It has continued to improve over and over again, as it has evolved into; Part A which is Hospital Insurance, Part B – Medical Insurance and Medicare Part C is a Medicare Advantage Plan which we would be discussing hereafter and Medicare Part D, which is Medicare Prescription Drug Coverage.
This plan as it is different from the others is controlled by private institutions such as; private insurance companies, union, religious organizations or others. These institutions are contracted by government on a yearly basis. Once registered for this plan, you are still under your Part A or Part B, but getting your services from a private institution. In addition, your medical needs are now paid per capita.
There is additional health services compared to being just under the Original Medicare, but may incur additional charges. This additional cost varies according to the amount of healthcare an enrolled individual needs. Medical supplement insurance is not needed in this type of plan. Some of the services provided by this health plan include claims & payment processing, investigating fraud, clinical enrollment and call center services.
What is covered by Medicare Advantage plan?
Advantage plan covers the following:
- Self-administered prescription drugs.
- Dental care.
- Vision care.
- Annual Physicals.
- Coverage outside the United States.
- Out of Pocket limit (OOP).
- Health club memberships
There is also a reduction in the 20% co-pays and high rate of deductions, as seen in the Original Medicare.
Some of the plans covered here are;
- Health Maintenance Organization (HMO): Here you are restricted from getting services outside a specific network of local providers. An exception exists for emergency and urgent situations.
- Point of service plans (POS): This is similar to HMO. Here you can see providers outside the specific network but at more cost.
- Preferred Providers Plan (PPS): Here you can see providers for all your covered services but at more expense.
- Private Fee for Service (PFS): This is clearly more costly than the other plans, as your fees are paid as services are rendered.