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Medicare Advantage Plans


A Medicare Advantage Plan is an  insurance plan that is an alternative to Original Medicare. Medicare pays the plan to administer your Part A and B benefits. 


You must continue to stay enrolled in both Medicare Part A and B while enrolled in your Medicare Advantage plan.


These plans resemble group insurance typically offered through employers; there is a local network of providers that you will use and co pays for many routine services like doctor’s visits, lab-work, ambulance, surgeries, hospital stays, urgent care and more.


It is in your interest to enroll in Medicare Advantage through a qualified, licensed insurance agent who can fully explain how the plan works.  Without an agent, you could find yourself enrolled in a plan that your doctor doesn’t accept or that doesn’t include one of your medications!

There are several types of Medicare Advantage plans. These are the two primary categories of MA plans: HMO and PPO.

HMO - Health Maintenance Organization

HMO stands for Health Maintenance Organization. HMOs have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members.


There are 2 features that set HMOs apart from other types of healthcare plans: cost and choice.

COST

HMO usually offers lower monthly premiums than other types of insurance plans. They also tend to have lower co-pays and coinsurance, which helps make them more affordable. HMOs are an affordable option for people who don’t usually need anything more than basic medical care like annual checkups or immunizations.

Even though costs are generally lower with an HMO, they don’t cover any out-of-network care, except in a true emergency.

CHOICE OF PROVIDERS

You must choose a primary care physician (PCP) from a network of local healthcare providers when you join. This is the doctor you will see whenever you need medical care. Your PCP will be the provider with the best overall picture of your health and will be the one to coordinate any additional care you might need.


If you were to need the care of a specialist, you would first see your PCP. Then, if needed, he or she would provide a referral to a specialist within the HMO’s network.

PPO - Preferred Provider Organization

PPO stands for Preferred Provider Organization. Just like an HMO, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate.

But there are some differences. Some key things to consider when deciding if a PPO plan is right for you.

FLEXIBILITY

A PPO offers you the freedom to receive care from any provider—in or out of your network. This means you can see any doctor or specialist, or use any hospital.


In addition, PPO plans do not require you to choose a primary care physician (PCP) and do not require referrals. No referrals are required for any doctor, specialist or hospital.


Another bonus: If you find yourself in need of medical care when you are away from home, you can see any Medicare healthcare provider you choose.

COST

A PPO health insurance plan provides more choices when it comes to your healthcare, but there will also be higher out-of-pocket costs associated with these plans.


Your monthly premiums will be higher and your co-pays for office visits will also cost more. Plus, there is also an annual deductible that must be met.


Using in-network providers, doctors and other healthcare professionals who are a part of your PPO network will save you money.

Special Needs Plans (SNPS)

Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, SNPs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some SNPs offer additional benefits, such as vision and hearing care.


All SNPs are designed to meet specific care needs, and you can only join a SNP if you fit the special needs category the plan serves. SNPs may provide care and coverage coordination services not offered by other types of Medicare Advantage Plan. There are three types of SNPs:

Chronic Condition SNPs (C-SNPs)

For individuals with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and certain neurologic disorders

Institutional SNPs   (I-SNPs)

For individuals who live in an institution, such as a nursing home, long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility

Dual Eligible SNPs   (D-SNPs)

For individuals enrolled in Medicare and Medicaid (dually eligible individuals)

Appointments can be done In-Person, over the Phone, Email, or other Virtual Methods!

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Some Reasons to Choose Medicare Advantage

  • Many plans have low monthly premiums - some have zero! (although you must continue to pay your Medicare Part B premium)
  • Some medical services have copays and coinsurance
  • Medicare Advantage plans have an out of pocket maximum cap to protect against catastrophic costs (unlike Original Medicare!)
  • Medicare Advantage Plans offer the option of having your Part D drug benefits included!
  • Plans may also include benefits for hearing aids, coverage for eyewear and dental care annually

Is an HMO plan right for me?

There are several factors to take into account when choosing whether an HMO plan is the right option for you. Some key things to consider are:


  • Cost of monthly premiums
  • Out-of-pocket costs
  • Using a PCP vs. choosing your own healthcare providers
  • The current health of the people you want to cover


If you are someone who doesn’t need a lot of specialist care or don’t mind having your care coordinated through a PCP, you can save money with an HMO plan.

Is a PPO right for me?

A PPO is generally a good option if you want more control over your choices and don’t mind paying more for that ability


It would be especially helpful if you travel a lot, since you would not need to see a primary care physician.


The key to finding the right plan for you is to strike a balance between the coverage you want and the premium you can afford.

Your Medicare SNP may be a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO)


SNPs are not available everywhere. To find out if there is a SNP available in your area, reach out to me for a no obligation assessment!