Medicare Advantage Plans

There are four parts of Medicare. Each one helps pay for different health care costs.

Parts A and B

This is what's called Original Medicare. It helps pay for hospital and facility costs, including hospice care and home health care. It also helps pay for medical costs outside a hospital, including doctor visits and preventive care.

Part C

This is called Medicare Advantage. It covers everything Original Medicare does, but it also puts a limit on your out-of-pocket costs. Some of these plans also cover preventive dental, vision and hearing costs. They're only available through private health insurance companies, like Blue Cross.

Part D

This plan type helps pay for prescription drugs. It covers commonly used brand-name and generic drugs. Some plans cover more drugs than others. These plans are also only available through private health insurance companies.

These terms all describe money you pay toward health care when you have a health insurance plan.

Copays and coinsurance

A copay is a fixed amount of money you pay for a certain service. Your health insurance plan pays the rest of the cost.

Coinsurance refers to percentages.

Our Medicare Advantage plans use copays for most services. You pay 20 percent coinsurance for most services with Original Medicare. 

Deductible

A deductible is the amount of money you pay for care before your plan starts paying. For most services, you'll pay the full cost until you reach the deductible. After you reach your deductible, you’ll still have to pay any copays or coinsurance.

Most Medicare Advantage plans have separate medical and pharmacy deductibles. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. We pay the Original Medicare deductibles for you.

How they all work together

When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. When you reach a certain amount, we pay for most covered services. This is called the out-of-pocket maximum.

Original Medicare doesn’t have an out-of-pocket maximum. There's no cap on what you pay out of pocket. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. After that point, you pay the full amount each day.

These acronyms all signify different health plan types:

• PPO stands for preferred provider organization.
• HMO stands for health maintenance organization.
• POS stands for point of service.

PPO plans

PPO plans have more flexibility than HMO plans. You don’t need a primary care physician. You can see doctors inside or outside your network. But if you stay in your network, you’ll pay less.

If you want to be able to coordinate your own health care, a PPO plan might be right for you.

HMO plans

When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and can refer you to trusted doctors and specialists in your network. It's important to note that, with an HMO plan, most health care isn't covered outside your network. 

If you want low monthly premiums and copays and you don’t travel much, an HMO plan might be right for you.

HMO-POS plans

HMO-POS plans work a lot like HMO plans. The main difference is that you can see doctors outside your network in some cases. That's where the "POS," or "point of service," part comes in. With our HMO-POS plans, it means you can get routine health care when you travel nationwide.

If you do a lot of traveling within the U.S. and you want one doctor coordinating all your care, an HMO-POS plan might be right for you.