People with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans contain 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) which were available because the 1980’s.
To help your parents (or you) make an educated decision, they need to know the way these plans work, and then decide which plan is right for them. The next is just a brief description of each of the plan types.
If a person elects to opt for traditional fee for service Medicare, they are able to generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare comes with deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.
Medicare Advantage Plans (Part C)
In the event that you opt to opt for a Medicare Advantage Plan, you really trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are given 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 the exact same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are appealing to Medicare eligible individuals simply because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by traditional Medicare.
Individuals considering a Medicare HMO should bear in mind that they may only receive medical services from providers who are area of the HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a primary care physician from those who take part 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 won’t purchase unauthorized visits to specialists nor non-emergency care received away from 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 away from 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 can be purchased in many aspects of the country. These plans serve large geographic areas and must offer the exact same premium Myaarpmedicare costs and plan benefits to all or any individuals residing in these areas. Medicare PPO’s cover the exact same forms of medical expenses that traditional Medicare does. Additionally, Medicare PPO’s commonly incorporate 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 quantity a person can spend on covered medical expenses in a calendar year. Much like any PPO program, when a person works on the non-contracted provider for covered services, they’ll pay more out of the pocket.
These plans can be found to Medicare beneficiaries in trade because of their traditional Medicare Benefits. PFFS don’t have an official network of doctors and hospitals to pick from and not all doctors or hospitals are willing to offer medical services to participants in these kinds of plans. If a person is considering enrollment, it’s wise to check on using their doctor and local hospitals to ensure 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 as the fee for service plans decide just 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 incorporate a prescription drug benefit. If they do not, the enrollee is free to participate a Medicare standalone prescription drug plan.
These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help paying for their medical benefits. These would include individuals who qualify for both Medicare and Medicaid (MediCal in California), those residing in longterm care facilities, and individuals with chronic or disabling medical conditions.
Prescription drug plans can be found to all or any Medicare eligible persons irrespective of medical history or income levels. Each time 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 these January 1st.
Medicare drug plans are designed to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there is a monthly cost for these plans. As well as a monthly premium, the covered individual is needed to pay a percentage of the cost of the medications (or a copay) and Medicare pays area of the cost. Costs for a plan will change depending on the medications taken and the type of plan selected. At least, the plans available must provide a “standard” amount of coverage.