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Orlando Florida Medicare Advantage Plans (Part C)

What are Medicare Advantage Plans?

Medicare Advantage (MA) Plans are health plan options approved by Medicare and offered by private insurance companies that are contracted by the federal government (the Centers for Medicare & Medicaid Services, or CMS). These plans are part of Medicare and are also called Part C or MA Plans. Medicare Advantage Plans provide Medicare hospital and medical insurance (Part A and Part B) and usually Medicare prescription drug coverage (Part D). They are not supplemental insurance (i.e. Medicare Supplement Plans). Medicare Advantage (Part C) Plans must provide benefits equivalent to Original Medicare, but most plans also offer additional benefits as well. These additional benefits may vary by plan.

 

Consumers are eligible to join a Medicare Advantage Plan if they meet these conditions:

 •        Entitled to Medicare Part A and enrolled in Medicare Part B

•         Live in the service area of the plan

•         Do not have End Stage Renal Disease (ESRD)

 

Medicare Advantage Plan Types

There are several different Medicare Advantage (MA) Plans and each of them has distinct features. Consumers may only be enrolled in one Medicare Advantage Plan at any time.  Below are four types of Medicare Advantage Plans.

 

HMO – Health Maintenence Organization
POS – Point of Service Plan
PPO – Preferred Proivder Organization
RPPO – Regional Preferred Proivder Organization

 

Key Features of MA Plans

Premiums

Some, but not all MA Plans, have $0 monthly health plan premiums. Premium and benefit levels vary by Plan and service area.

Prescription Drug Coverage

•         Most MA Plans include integrated Medicare Part D Prescription drug coverage. These Plans are referred to as MA-PD Plans. Please refer to the Prescription Drug Plan certification module to review enrollment rules and restrictions related to Part D coverage.

 •         A member cannot be enrolled in an MA-Only Plan and keep their existing Stand-alone Prescription Drug Plan (PDP), with the exception of the PFFS Plan and the Medicare Savings Account (MSA) Plan.

•         A consumer may enroll in a PFFS or MSA MA-Only Plan if they have a stand-alone PDP. (See the separate PFFS certificaton module for more information on PFFS plans.)

•         If a consumer enrolls in any other MA-only plan, he or she will be disenrolled from his or her PDP plan and will not be allowed to get Part D coverage until the next Annual Election Period.

•         A member cannot be enrolled in an MA-Only Plan and keep their existing Stand-alone Prescription Drug Plan (PDP), with the exception of the PFFS Plan and the MSA plan. The MA- Only enrollment will cause the member to lose their current Stand-alone Prescription Drug Plan (PDP) coverage. If the member loses their PDP coverage due to MA-PD enrollment they may be excluded from enrolling in a PDP until the next Annual Election Period.

Networks

HMO, PPO and POS plans are network-based plans. For HMOs, the plans contract with a provider network and members must use these providers in order to receive benefits for covered services. In the case of PPO and POS plans, members may access out-of-network providers but will likely incur a higher out-of-pocket cost. Note that with a POS plan, not all benefits may be available out-of-network.
•         Some, but not all plans, require the member to select a Primary Care Physician (PCP) to coordinate all of their care with specialists and hospitals. In some cases, a PCP referral is required in order for the member to receive access to specialists.
•         Refer to specific Plan descriptions to determine if there are prior authorization or referral requirements in order to access specialists.

Consumer Characteristics

What are the characteristics of consumers who may be most interested in a Medicare Advantage Plan?

•         Consumers who want to reduce monthly premiums

•         Consumers who would like to benefit from the additional coverage and more predictable costs

•         Consumers who want an integrated Medicare prescription drug coverage (Part D)

•         Consumers who want to benefit from coordinated care of Hospitals and Specialists

•         Consumers who want to limit out-of-pocket expenses