What is it? A Medicare Advantage Plan is a type of Medicare health plan offered by a private company, such as Independence Blue Cross, that contracts with Medicare to provide all Part A and Part B benefits. If enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare.

Plan types offered: Medicare Advantage Plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), for example. Independence offers Keystone 65 HMO as well as Personal Choice 65 PPO.

Medical Coverage: If enrolled in a HMO, members must choose a PCP (which also will coordinate referrals) and must stay In-Network. PPO plans do not require enrollment with a PCP and there are no referrals. Members can go out of network, but cost-sharing is typically higher.

Prescription Drug Coverage: Most MA plans, including KS65, include prescription drug coverage (Part D), which is included in the overall monthly premium.

MOOP: Has a maximum out of pocket to protect from catastrophic illness.

How coverage works: The carrier of the plan is the payer. Medicare pays monthly stipends for each member.

If you have any questions, please contact your Total Benefit Solutions, Inc Medicare specialists at (215)355-2121.