How Do Medicare Advantage Plans Pay For Hospital Stays?

The Medicare system covers millions of people. Individuals who are eligible for Medicare can receive coverage through the traditional Medicare program or from plans offered by private insurance companies and approved by Medicare. These approved companies must adhere to Medicare’s rules and regulations. Millions of people on Medicare have chosen to become members of Medicare Advantage Plans.

What are Medicare Advantage Plans?

Medicare Advantage Plans (also Medicare called part C), are private insurance packages; they are a type of Health Maintenance Organization (HMO). There are several different types of Medicare Advantage Plans, and each has different features and requirements; some also differ in regard to the amount of out-of-pocket fees
paid by the beneficiary annually.

What are the different types of MA Plans?

The major types of MA Plans include:

• HMO Plans. (Health Maintenance Organizations).
• PPO Plans. (Preferred Provider Organizations).
• PFFS Plans. (Private Fee-for-Service Plans).
• SNP Plans (Special Needs Plans).

What do a Medicare Advantage Plans cover?

Medicare Advantage plans cover:
• doctor visits
• emergency care
• hospitalization, including in patient and outpatient services.
• skilled nursing care and home health care.

How do Medicare Advantage Plans pay for hospitalization services?

Medicare pays a specific amount of money to companies offering Medicare Advantage Plans, for an individual’s healthcare once a month. Medical Advantage Plans pay for hospitalization, including in patient and outpatient services. However, there may be a deductible for hospital stays under some plans. All plans cap the amount of co-pays and deductibles paid annually by the beneficiary.

Medical Advantage Plans include the same features as the basic Medicare program, and some plans include extra features. Although Medicare Advantage Plans do not pay for hospice care, they include comprehensive hospitalization coverage, emergency and urgent care, and all other items covered by traditional Medicare.

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