Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies to help cover out-of-pocket costs associated with Medicare Part A and Part B. Some Medicare Advantage plans may also provide additional benefits such as hearing care, vision and dental care, and some medical services.
The following are the common types of Medicare Advantage plans:
Health Maintenance Organization Plans
In health maintenance organization plans, the recipients must get healthcare services from the providers that have been approved by the plan. The only services that beneficiaries can get outside the network are out-of-area dialysis, emergency care, and out-of-area urgent care.
However, the out-of-pocket costs are reduced if you stay within the network of approved providers. Many HMO plans cover prescription drugs though the only way to be sure is to ask the provider. In HMO plans, beneficiaries will need to select a primary care doctor and may need to get a referral to see a medical specialist for some services.
Beneficiaries will be responsible for the full cost if they go outside the plan’s network.
Preferred Provider Organization Plans
A PPO plan is another Medicare Advantage plan offered by private insurers. In a PPO plan, there is a network of hospitals, healthcare providers, and doctors. Beneficiaries will pay less if they visit healthcare providers that belong to the network. However, they can go outside the network for services and care; they will just pay more.
Prescription drugs are covered in most PPO plans. For beneficiaries who want Medicare drug coverage, they must join a PPO plan that offers prescription drug coverage.
Unlike HMO plans, there is no need to choose a primary care doctor or need a referral to see a specialist in most cases.
Private Fee-for-Service
In PFFS plans, there is a specific amount the plan covers for medical services. The beneficiary has a fixed amount they will pay after getting medical care. In some cases, the recipients can get medical care from any healthcare provider or doctor who accepts the terms.
However, if the plan has a network of approved healthcare providers, it will be cheaper to stay within the network. Also, there is no need to choose a primary care doctor in PFFS plans or get a referral for specialist visits.
Special Needs Plans
Special Needs Plans are limited to people with certain conditions or specific diseases. The benefits, formularies, and provider choices have been modified to suit the people who need the coverage. Beneficiaries of this plan must get healthcare services from approved providers except for out-of-area dialysis and emergency care.
All Special Needs plans also cover prescription drugs. To see a specialist in SNPs, recipients will need to get a referral.
For more information about Medicare Advantage plans, contact a Medicare agent with Meservey & Associates. We will ensure you are completely informed of all your Medicare options.
