People with 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, the majority are enrolled in HMO’s (Health Maintenance Organizations) which were available considering that the 1980’s.
To greatly help your parents (or you) make an educated decision, they have to know how these plans work, and then decide which plan is right for them. The next is a brief description of each of the plan types.
Original Medicare
If someone elects to choose traditional fee for service Medicare, they could 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 could 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 opt to choose 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 if any cost besides continued payment of these Part B monthly premiums.
Medicare HMO’s (Health Maintenance Organizations)
These plans cover the exact same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are attractive to Medicare eligible individuals simply because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits that are not covered by traditional Medicare.
Individuals considering a Medicare HMO should bear in mind they can only receive medical services from providers who’re part of the HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a main care physician from those who be involved in their network. This primary care physician would then lead to 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 outside the 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 very important areas. First, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, second, Medicare PPO’s don’t usually require that you obtain an authorization before seeking care from the specialist.
Regional PPO’s are available in many aspects of the country. These plans serve large geographic areas and must offer the exact same premium costs and plan benefits to any or all individuals residing in these areas. Medicare PPO’s cover the exact same kinds of medical expenses that traditional Medicare does. Furthermore, Medicare PPO’s commonly include 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 amount someone can invest in covered medical expenses in a calendar year. Just like any PPO program, when someone uses a non-contracted provider for covered services, they’ll pay more out of these pocket.
These plans can be found to Medicare beneficiaries in trade due to their traditional Medicare Benefits. PFFS don’t have an official network of doctors and hospitals to select from and not totally all doctors or hospitals are willing to offer medical services to participants in these kinds of plans. Myaarpmedicare.com If someone is considering enrollment, it’s wise to test using their doctor and local hospitals to make sure that they’ll accept the plan’s payment for services before enrolling. Also, the enrollee should thoroughly understand the advantages of a fee for service plan because the fee for service plans decide how much they’ll purchase Medicare covered services and may charge a higher cost sharing percentage than traditional Medicare. Private fee for service plans may include a prescription drug benefit. If they don’t, the enrollee is free to join a Medicare stand alone prescription drug plan.
These plans are private plans that offer benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help paying for their medical benefits. These would include folks who qualify for both Medicare and Medicaid (MediCal in California), those residing in long term care facilities, and people that have 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. Whenever a person first qualifies for Medicare, their initial enrollment period begins 3 months before their 65th birthday, includes their birth month, and ends 3 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 force away catastrophic drug costs. However, there is a regular cost for these plans. Along with a regular premium, the covered individual must pay a portion of the expense of the medications (or a copay) and Medicare pays part of the cost. Costs for an idea will vary with respect to the medications taken and the type of plan selected. At least, the plans available must give a “standard” level of coverage.