Understanding the most common types of Medicare Advantage Plans is essential when choosing what plan you want for yourself. So let’s take a closer look at Medicare Advantage Plans.
Medicare Advantage Plans are just another way to get coverage like Medicare Plans A and B do. This type of plan is often referred to as Medicare Plan C. There are four common plans within Plan C. These plans are provided by private insurance companies and have to follow the same rules set up by Medicare. If you choose Medicare Plan C, you’ll often have to go to specific doctors or practitioners. So, what are the four most common types of Medicare Advantage Plans, then? There is a Health Maintenance Organization Plan, Preferred Provider Organization Plan, Private Fee-for-Service Plan, and a Special Needs Plan. Most plans under Plan C cover prescription drugs which are also part of Medicare Plan D, but it’s always important to ask your provider.
Health Maintenance Organization Plan (HMO)
The main takeaway about this plan is that only certain doctors are registered within it, and you can only go to them. If you see someone outside of this network, you will most likely have to pay out of pocket for whatever service you received. When you sign up for this plan, you can choose whom you want to be your primary care provider. If at any time your provider decides to no longer work with HMO plans, you will be notified, and you can pick a new one.
Suppose you need a particular service done while on this Medicare plan; you will often need a referral before the service is done. It is essential to ensure that your insurance provider knows about the screening before you get it done in case they may not cover it. The insurance should provide yearly screenings, and you most likely won’t need a referral.
Preferred Provider Organization Plan (PPO)
Like the Health Maintenance Organization Plan, the PPO plan has a specific network of doctors you can work with. The difference is that you may see anyone in the network with the PPO plan, whereas, with the HMO plan, you have to see the specific doctor you choose. The PPO plan also covers prescription drugs, as most Medicare Plan C’s do. Another difference is that you don’t need a referral to see a specialist. Something nice about this plan is that if you see a doctor or a specialist outside of the network, the insurance will still try to help cover some costs.
Private Fee-for-Service Plan (PFFS)
This plan differs from the other two listed above because you can mostly go anywhere and see whom you’d like. In some cases, some insurance companies will have their own doctors within their network; if you choose to see them, the cost you pay will be lower. How this plan works is that the insurance decides how much they will pay the doctor and how much you will pay for your care. To receive your care, it will depend on the doctor or provider and if they agree to work with your insurance provider. This plan can get tricky because even if you’ve seen a specific doctor in the past, they can choose not to work with you.
It’s best to check with your insurance provider and the doctor first before you plan to get treated or see them in case they reject your plan.
Special Needs Plans (SNP)
The Medicare Special Needs Plan is tailored specifically to people with specific diseases or other limitations. Usually, these plans aren’t just offered to everyone; often, a doctor will refer you for this type of plan. Unlike the other Medicare C plans, where you can enroll at age 65, anyone can join an SNP anytime. Another difference in this plan is that all SNPs must cover drug prescriptions, whereas the others may or may not.
Get in Touch With A Medicare Insurance Agent Today
I work with various clients who all have different needs. It may seem overwhelming, but don’t let all of the plans worry you. I have years of experience and will guide you in selecting the best Medicare Advantage Plan for your specific needs. Call (912) 660-5236, and we can discuss what you’re looking for.