People who have Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans include HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, almost all are enrolled in HMO’s (Health Maintenance Organizations) which were available since the 1980’s.
To help your parents (or you) make the best decision, they should know the way these plans work, and then decide which plan is right for them. The next is just a brief description of all the plan types.
Original Medicare
If an individual elects to choose 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 does have deductibles, copays and cost sharing requirements that could 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)
If you opt to choose a Medicare Advantage Plan, you really trade your traditional Medicare benefits for these plans. Lots of the Medicare Advantage Myaarpmedicare Plans are given to eligible individuals at minimum cost apart from continued payment of their 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 attractive to Medicare eligible individuals simply because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits that are not included in traditional Medicare.
Individuals considering a Medicare HMO should bear in mind that they’ll 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 primary care physician from those that be involved in their network. This primary care physician would then be responsible for 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 essential 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 do not usually require that you obtain an authorization before seeking care from a specialist.
Regional PPO’s are available in many areas of the country. These plans serve large geographic areas and must offer exactly the same premium costs and plan benefits to all or any individuals residing in these areas. Medicare PPO’s cover exactly the same kinds 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 amount an individual can spend on covered medical expenses in a calendar year. Much like any PPO program, when an individual works on the non-contracted provider for covered services, they will pay more out of their pocket.
These plans can be found to Medicare beneficiaries in trade 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 supply medical services to participants in these kinds of plans. If an individual is considering enrollment, it’s wise to check using their doctor and local hospitals to ensure that they will accept the plan’s payment for services before enrolling. Also, the enrollee should thoroughly understand the advantages of a fee for service plan since the fee for service plans decide how much they will purchase Medicare covered services and may charge a greater cost sharing percentage than traditional Medicare. Private fee for service plans may incorporate a prescription drug benefit. If they don’t, the enrollee is free to participate a Medicare stand alone prescription drug plan.
These plans are private plans offering 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 longterm care facilities, and those with chronic or disabling medical conditions.
Prescription drug plans can be found to all or any Medicare eligible persons no matter medical history or income levels. Whenever 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 these January 1st.
Medicare drug plans are designed to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there’s a monthly cost for these plans. In addition to a monthly 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 agenda can vary with regards to the medications taken and the type of plan selected. At least, the plans available must supply a “standard” level of coverage.