Medicare Advantage Plans and The Extended Service Area

Posted:October 28, 2016

Medicare Advantage plans are Medicare health plans offered by private insurance companies. They are required by law to cover all services provided by Medicare Part A and Medicare Part B. Many Medicare Advantage plans also cover Medicare Part D prescription drugs. These plans are called MAPD plans (Medicare Advantage + prescription drug).

Medicare Advantage plans can be offered in the form of Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). HMOs and PPOs have a provider network, where in-network providers contract with the insurance company to provide medical services to a plan’s members. Medicare beneficiaries who choose Medicare Advantage plans can be concerned that their doctor won’t be in-network.

These provider network concerns have led to the development of the group “Passive PPO,” also known as an “Extended Service Area (ESA)” benefit. As the names imply, this benefit is most commonly available via group underwriting, and extends a PPO’s service area to include any provider who is eligible to receive payment from Medicare.

If your local union works with Labor First to administer your retiree MAPD, you can contact our team of Retiree Advocates to learn more about the MAPD’s Extended Service Area.