People who have Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans consist of HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, most are enrolled in HMO’s (Health Maintenance Organizations) that have been available considering that the 1980’s.
To greatly help your parents (or you) make an informed decision, they need to know the way these plans work, and then decide which plan is right for them. The following is just a brief description of all the plan types.
If someone elects to go with traditional fee for service Medicare, they can generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare does have deductibles, copays and cost sharing requirements that can play havoc with budgets. To greatly help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.
Medicare Advantage Plans (Part C)
If you choose to go with a Medicare Advantage Plan, you really trade your traditional Medicare benefits for these plans. Most of the Medicare Advantage Plans are offered to eligible individuals at little or no cost other than continued payment of the Part B monthly premiums.
Medicare HMO’s (Health Maintenance Organizations)
These plans cover exactly the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are appealing to Medicare eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits that aren’t covered by traditional Medicare.
Individuals considering a Medicare HMO should bear in mind that they can only receive medical services from providers that are part of the HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a key care physician from people who be involved in their network. This primary care physician would then result in all medical care including referrals to a specialist and admittance to a hospital. The HMO will not purchase unauthorized visits to specialists nor non-emergency care received beyond your HMO’s service area or visits to non-network physicians.
These plans are private healthcare plans like HMO’s. However, PPO’s and HMO’s do differ into two essential areas. First, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals beyond your PPO network. And, second, Medicare PPO’s do not usually require that you obtain an authorization before seeking care from a specialist.
Regional PPO’s are available in many aspects of the country. These plans serve large geographic areas and must offer exactly the same premium costs and plan benefits to any or all individuals residing in these areas. Medicare PPO’s cover exactly the same forms of medical expenses that traditional Medicare does. Furthermore, Medicare PPO’s commonly add a prescription drug benefit. Unlike traditional Medicare, Medicare PPO’s have an annual out of pocket limit for benefits covered under Parts A and B of Medicare. The out of pocket limit caps the total amount someone can spend on covered medical expenses in a calendar year. As with any PPO program, when someone uses a non-contracted provider for covered services, they’ll pay more out of the pocket.
These plans can be found to Medicare beneficiaries in exchange because of their traditional Medicare Benefits. PFFS don’t have a proper network of doctors and hospitals to select from and not absolutely all doctors or hospitals are willing to offer medical services to participants in these kinds of plans. If someone is considering enrollment, it is wise to check using their doctor and local hospitals to make sure that they’ll accept the plan’s payment for services before enrolling. Myaarpmedicare Also, the enrollee should thoroughly understand the benefits of a fee for service plan as the fee for service plans decide simply how much they’ll purchase Medicare covered services and may charge a greater cost sharing percentage than traditional Medicare. Private fee for service plans may add a prescription drug benefit. If they cannot, the enrollee is free to join a Medicare standalone prescription drug plan.
These plans are private plans that offer benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help spending money on their medical benefits. These would include folks who qualify for both Medicare and Medicaid (MediCal in California), those residing in longterm care facilities, and those with chronic or disabling medical conditions.
Prescription drug plans can be found to any or all Medicare eligible persons no matter medical history or income levels. Each time a person first qualifies for Medicare, their initial enrollment period begins three months before their 65th birthday, includes their birth month, and ends three months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on the following January 1st.
Medicare drug plans are made to reduce drug costs for enrollees and drive back catastrophic drug costs. However, there’s a monthly cost for these plans. Along with a monthly premium, the covered individual must pay a share of the expense of the medications (or a copay) and Medicare pays part of the cost. Costs for an idea will vary depending on the medications taken and the type of plan selected. At a minimum, the plans available must give a “standard” degree of coverage.