Typical Medicare Advantage Plans & their Benefits
Medicare Advantage Plans can work in several different ways. All Medicare Advantage Plans have networks except Private Fee For Service (PFFS) plans. It is very important that you understand your plans network, and its restrictions and limitations.
Health Maintenance Organization (HMO)
With a Health Maintenance Organization or HMO, you must use doctors, hospitals and other healthcare providers in the HMO network with some very rare exceptions. In almost all cases, you will be required to choose a Primary Care Provider (PCP) with an HMO. All care received from a specialist will require a referral from your Primary Physician.
Private Fee-for-Service (PFFS)
With the majority PFFS plans, although very few still exist, you are able to choose any doctor or hospital that accepts Medicare and the PFFS terms of service and payment.
Preferred Provider Organization (PPO)
PPO plans do have network doctors, hospitals, and other healthcare providers. Although with a PPO, in most cases, you can receive out-of-network care, but at a higher cost than you would pay within the network.
What are the Positives & the Negatives of Choosing a Medicare Advantage Plan?
An MA Plan Has Very Low Upfront Costs
They Have Predictable Annual Maximum Out-of-Pocket Expenses
Almost all MA Plans Offer Drug Coverage
Many Medicare Advantage Plans Offer Dental,Vision and Hearing Benefits
You Can Change Plans Each and Every Year with No Underwriting Questions
MA Plans Have Unpredictable Costs Like Co-payments and Deductibles
MA Plans Network Restrictions Without Nationwide Coverage While Traveling
If You Need To See a Specialist It Will Require a Referral with an HMO Plan
The Medicare Advantage Plan Can Change Your Plans Benefits and Network Providers Each Year
Enrolling in a Medicare Advantage Plan
There are very specific times throughout the year known as enrollment periods when you can enroll in a Medicare Advantage plan. Speak with one of our SecureCare65 licensed agents about your eligibility.
Many seniors feel Medicare Advantage plans are very attractive because they have low, or in some cases no premium. You need to be aware of potential hidden costs and loopholes that can cause you an unanticipated medical expense. All Medicare Advantage Plans have maximum out-of-pocket limits. This amount cannot exceed $6,700 a year in 2018.
Make sure you are aware of all of the benefits. Does the MA plan have prescription drug coverage? What are the MA plan’s annual deductible and out-of-pocket maximums? Does the MA plan have network restrictions?
Since Medicare Advantage plans are not standardized like Medicare Supplemental Insurance, they are more difficult to compare. There are also very strict rules put in place by the insurance company that you must abide by when using your Medicare Advantage plan. These rules vary by company, and type of MA plan. Make sure you are well aware of any restrictions before purchasing any MA plan.
Medicare Advantage plans are not for everyone, that’s for sure, but if upfront cost is your primary concern, it could be a good option. Before you make a final decision, SecureCare65 highly recommends speaking with one of our licensed agents. We can help determine your eligibility and needs. We will also explain other low-cost options that offer comprehensive health insurance coverage with more Freedom of Choice.
