Medicare Advantage
Private plans, called Part C, that replace traditional Medicare and usually bundle drug, dental, and vision benefits.
Overview
The government pays the insurer a monthly amount per member, adjusted for health risk, and plans manage networks, prior authorization, and cost sharing inside annual limits. More than half of Medicare beneficiaries now enroll, drawn by low or zero premiums and the out of pocket maximum that traditional Medicare lacks. Tradeoffs include network restrictions, referral rules, and prior authorization denials that draw complaints and audits. Plans can change benefits and networks every year, and switching back to traditional Medicare later carries medigap underwriting risk in many states after the first eligibility window. Published star ratings grade plans yearly and drive bonus payments to carriers.
Related Topics
Health Maintenance Organization
Members choose a primary doctor who manages care and writes referrals to specialists, and care outside the network is generally no...
Preferred Provider Organization
Members can see specialists without referrals, the main convenience over HMOs. In network care might be covered at 80 or 90 percen...
High Deductible Health Plans
Until the deductible is met members pay the full negotiated price for most care, though preventive services are exempt from the th...
Health Savings Accounts
Contributions are deductible, growth is untaxed, and withdrawals for qualified medical expenses are tax free, a combination no oth...