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Medicare Advantage Plans and Other Options

Auther: Usseek

Created On: 10/20/2019 6:30:00 PM

Medicare Advantage Plans provide more benefits than Original Medicare. You will get the most of your Part A (Hospital Care) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan. Medicare Advantage Plan may include coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage and fitness center membership.

Medicare Advantage Plans have many options that you can choose from. Most of the plans offer Medicare prescription drug coverage (Part D). Some offer health care providers that take part in the plan’s network. There are plans that offer out-of-network coverage but at a higher cost. Just remember, you need to use your Medicare Advantage Plan card to get your Medicare-covered services.

DIFFERENT MEDICARE ADVANTAGE PLANS

1. HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN

HMOs are private plans that pay to administer Medicare benefits. HMO provides you the same benefits, rights, and protection as the Original Medicare, but with different rules, restrictions, and costs. Under HMO, you will get your health care and services from doctors and hospitals in the plan’s network. You may get health care from out-of-network for some services but at a higher cost. They may offer additional benefits such as vision and hearing care. You will use your HMO benefit card when you’re going to a doctor or hospital once enrolled in the HMO plan.

2. PREFERRED PROVIDER ORGANIZATION (PPO) PLAN

A Medicare PPO Plan is a Medicare Advantage plan offered by a private insurance company. You can have your health care from any doctor or hospital in this plan. PPO plans have a network of doctors, other health care providers, and hospitals. Each plan is flexible to choose a doctor, health care provider or hospital that isn’t accredited by the network, but mostly at a higher cost. In the PPO Plan, you are always covered for emergency and urgent care. Some Plans in PPO offered Prescription Drug Coverage, check Medicare.gov/plan-compare to know more about it.

3. PRIVATE FEE-for-Service (PFFS) Plan

PFFS isn’t the same as Original Medicare. The plan regulates how much it will pay for a doctor, health care providers or hospital and how much a plan holder will pay to get the services. PFFS Plan has a network of doctors, other health care providers and hospitals that are allowed to treat a plan member. You can see an out-of-network doctor, health care provider or hospital who accepts the plan terms, but it usually costs you lower if you stay in the network.

4. SPECIAL NEEDS PLAN (SNP)

Medicare SNPs limit its membership to people with specific diseases or characteristics. SNP modify their benefits, health care provider, and drug formularies to attain the specific needs of the cluster they serve. All SNP provide Medicare Prescription drug coverage. And usually, need to choose a primary doctor. It is better to check your SNP plan if it covers network or out-of-network services. Visit Medicare.gov/plan-compare to see if there is an available SNP plan in your area.

Between Oct 15 to December 7, anyone with Medicare can join, switch or drop a Medicare Advantage Plan. The coverage will begin on January 1, as long as the plan gets your request by December 7. Medicare Advantage Open Enrollment Period starts between January 1 to March 31, you can also make changes regarding your plan during this period.

If you want to join or switch Medicare Advantage Plans, visit Medicare.gov/plan-compare or call 1-800-MEDICARE.

For more inquiries about Medicare Advantage Plans, visit Medicare.gov/publications.