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Frequently Asked Questions (FAQ)

What is a Medicare Advantage Plan?

A Medicare Advantage (Part C) plan is an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and typically include Part A (hospital), Part B (medical), and often Part D (prescription drug coverage). Many plans also offer extra benefits such as vision, dental, hearing, and fitness programs.

What is the difference between Original Medicare and a Medicare Advantage Plan?

Original Medicare is provided directly by the federal government and includes Part A and Part B. It allows you to see any doctor or hospital that accepts Medicare nationwide. Medicare Advantage Plans, on the other hand, are offered by private insurance companies. They must cover everything Original Medicare covers but may have different provider networks, costs, and additional benefits like dental, vision, or hearing.

What is a Medicare Supplement (Medigap) Plan?

A Medicare Supplement (Medigap) plan helps pay some of the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. These plans work alongside Original Medicare, not in place of it. They do not include prescription drug coverage, so many people pair them with a stand-alone Part D plan.

What is the difference between a Medicare Advantage Plan and a Medicare Supplement Plan?

Medicare Advantage (Part C) replaces Original Medicare with a plan offered by a private company and may include extra benefits. Medicare Supplement (Medigap) works with Original Medicare to help cover the costs Medicare doesn’t pay. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time.

What is a Medicare Advantage PPO Plan?

A Preferred Provider Organization (PPO) plan gives you flexibility to see both in-network and out-of-network doctors. You’ll pay less if you use providers in the plan’s network but can still go outside the network—usually for a higher cost.

What is an HMO Plan?

A Health Maintenance Organization (HMO) plan typically requires you to use doctors and hospitals within the plan’s network (except in emergencies). You usually need to select a primary care physician (PCP) and get referrals to see specialists.

What is an HMO-POS Plan?

An HMO-POS (Point of Service) plan is a type of HMO plan that allows you to go out of network for certain services, usually at a higher cost. It combines the structure of an HMO with the flexibility of a PPO.

What is the difference between a PPO and an HMO plan?

PPO (Preferred Provider Organization): More flexibility; no referrals needed; can see out-of-network doctors for higher costs. HMO (Health Maintenance Organization): Lower costs when staying in network; referrals usually required; less flexibility for out-of-network care.

What is a premium?

A premium is the monthly amount you pay to keep your Medicare plan active. You may still need to pay your Part B premium even if you enroll in a Medicare Advantage or Supplement plan.

What is a deductible?

A deductible is the amount you pay out of pocket for covered services before your plan begins to pay. For example, if your deductible is $200, you pay the first $200 of covered services yourself.

What is a copay?

A copay is a fixed dollar amount you pay for a covered service or prescription — for example, $20 for a doctor’s visit or $10 for a generic medication.

What is coinsurance?

Coinsurance is a percentage of the cost you pay for a covered service after meeting your deductible. For example, if your coinsurance is 20%, you pay 20% of the bill, and your plan pays 80%.

What does “Maximum Out-of-Pocket Expense” mean?

The maximum out-of-pocket (MOOP) limit is the most you’ll pay in a year for covered services. Once you reach this limit, your plan pays 100% of covered medical costs for the rest of the year. (Note: This limit applies to Medicare Advantage plans, not to Original Medicare.)

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Frequently Asked Questions (FAQ)