Medicare Advantage Plans are great stand-ins for Original Medicare coverage. However, there are several Advantage Plans to choose from, making the decision more challenging.
Before you make the ultimate decision, you must have a better understanding of your coverage needs so you can compare them with the coverage provided by each plan.
PPO Plans
PPO Plans, also known as Preferred Provider Organization Plans, allow you to see a specialist without a referral and visit doctors outside of the plan’s network. However, it may cost you more to do so. This is convenient for those who do not have a primary care doctor.
Because of this flexibility, PPO Plans often come with high premiums.
Features of Medicare PPOs may include things like:
- Lower co-pays with network providers
- Part D prescription drug benefits
- Ancillary coverage on things like vision, dental, hearing, & fitness memberships
- Transportation to doctor visits
- Nutrition programs
- Wellness programs
- Adult day-care services
HMO Plans
HMO Plans, also known as Health Maintenance Organization Plans, are the opposite of PPO Plans. To see a specialist, you will need a referral, as well as have a primary care provider within the plan’s network of providers. HMO Plans also have much lower premiums than PPO Plans.
Features of HMO Plans may include things like:
- Benefit summaries with a list of how much the network providers are allowed to charge for certain services
- Only one health question on the application
- Medicare Part D prescription drug coverage
Private-Fee-For-Service Plans
Private-Fee-For-Service (PFFS) Plans do not limit their beneficiaries to network providers. To receive services from a specific provider, they must first accept your plan’s payment terms and conditions.
This plan is also beneficial for those who frequently travel within the U.S. You can present your ID card at any Medicare-approved facility and ask if they accept the plan and can treat you.
With a PFFS Plan, you can either choose a separate Part D plan or choose a PFFS Plan with a built-in medication plan.
Advantage for Veterans
If you are a veteran, you may be receiving health coverage from TRICARE or VA. However, you may find that these plans restrict their coverage to VA facilities only. By having a Medicare Advantage Plan combined with your VA coverage, you can increase your benefits.
Benefits include:
- Increased coverage outside of VA facilities
- Out-of-pocket maximum limit
- Original Medicare coverage
- Dental
- Vision
- Hearing
- Over-the-Counter Medications
- Nutrition Programs
- Fitness Programs
- Adult Day-Care Services
- Transportation to and from Doctor Visits
- Services for Chronic Conditions
Special Needs Plans
Special Needs Plans (SNPs) provide care and coverage for specific situations and needs but are limited to beneficiaries with certain illnesses, chronic conditions, or eligible circumstances. SNPs also have a specific network of doctors.
There are three types of SNPs:
- Chronic Condition SNP: If you have a chronic disease or condition such as cancer, ESRD, cardiovascular disease, autoimmune disorders, HIV/AIDS, lung disorders, mental illness, or neurological disorders, you can qualify for Chronic Condition SNP.
- Dual-Eligible SNP: You can qualify for Dual-Eligible SNP if you have both Medicare and Medicaid.
- Institutional SNP: You can only qualify for Institutional SNP if you require institutional care, such as assisted living centers, nursing homes, or mental care facilities. You must also be living in this specific institution for no less than 90 days.
Deciding on which Medicare Advantage Plan is right for you can be an overwhelming process. That’s why we’re here to help. Reach out to a Midwest Medigap agent today to get the help you need.
