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Are Medicare Advantage Plans Really an Advantage


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While you may not be familiar with the term Medicare Advantage, you may know the following names and abbreviations that are actually Medicare Advantage plans - HMO, PPO, PFSP and MSNP. For clarity's sake, HMO stands for health maintenance organization, the PPO is for preferred provider organizations, the PFSP means private fee for service plans and MSNP represents Medicare special needs plans. The bottom line is this: all these initials mean flexibility in choosing a health care insurance plan that works for you.

You get a health insurance card with the Advantage plan, in addition to extra benefits and lower co-pays than those associated with the original Medicare plan. One of the restrictions here, though, is that you might only be able to see doctors belonging to the plan or use designated hospitals for services. Basically, choosing a Medicare Advantage plan might depend on how you feel about the doctors involved and whether or not you want to go to a certain hospital. Many people have personal preferences when it comes to choosing health care service providers.

Prior enrollment in Medicare part A and B, and payment of part B premiums, are required to be able to join the Advantage plan. If you're getting extra benefits, you will also be paying for those - however, in many cases the payments are much less than getting health insurance through a private carrier. It's good to remember that your Medigap policy won't work if you have the Advantage plan so you may wish to consider dropping it, although the choice is yours.

There are lots of things to consider when you decide what type of health care coverage you want for you and your family, not the least of which is whether you want to combine the original Medicare with Medigap, or opt for the Advantage plan. Talking to a reliable source, such as a fully qualified insurance broker, can be the difference between choosing something that sounds okay, but you're not sure about, and choosing something you have confidence will work, because you fully understand the details.

Richard Cantu is with Texas Health and Life, a Texas health insurance and Texas life insurance agency in Texas. To learn more, visit


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