Medicare Advantage Health Insurance products do not differ drastically from standard major medical plans; Advantage patients have the same options for levels of coverage and pricing structure. Carriers have recognized the need for choice and flexibility in senior healthcare, expanding their Medicare Advantage suites to include some of the most popular Individual and Family products.
The plans and coverage you choose will play a major role in determining your health care expenses, so make sure to think about your Costs through a Medicare Advantage Plan.
Return to the Medicare Advantage page >>
Medicare Health Maintenance Organization (HMOs) Plans
These plans usually require that you sign up for a certain “network” of health care providers. It may be one hospital or a group of doctors and other providers. You choose one doctor to be your primary care physician. In order to see a specialist, you need a referral (a letter of okay) from your doctor.
The HMO Plans will cover emergency services if you have an accident and are unable to reach your network doctors. If, however, you choose to see a doctor who is not in the network for a non-emergency situation, you may have to pay for that visit yourself.
If the HMO offers prescription drug coverage, there is usually a copay (an amount you pay for each prescription). Most HMOs cover preventive care, such as regular mammograms.
Medicare Preferred Provider Organization (PPOs) Plans
Preferred Provider Organization Plans, or PPOs, work a lot like the HMO Plans, above. Generally you pay less if you receive your care from a doctor who is within the PPO “network.” When you sign up, you’re given a list of health care providers within the network.
Unlike with HMOs, you don’t need a doctor’s referral to see a specialist under a PPO Plan. You can see any doctor or provider who accepts Medicare. If you do choose a provider who is not in the plan, you will usually pay more for their services than you would for a network provider.
PPO plan members can get their prescription drug coverage from the plan.
Details of each PPO differ, so read the plan or plans offered in your area to see if they suit your health care needs.
Request a free quote from carriers offering Medicare Advantage Products in your area >>
Medicare Special Needs Plans
These plans are designed to cover certain groups with special needs. Those groups with coverage are as follows:
• People in designated long-term care facilities
• People who are eligible for both Medicare and Medicaid
• People with certain chronic or disabling conditions.
Generally these plans offer lower copayments and more benefits than the Original Medicare. They are also required to provide prescription drug coverage.
Coverage may focus, for example, on additional nutrition or exercise counseling for those with diabetes or might provide those with limited income with help accessing community services.
Medicare Private Fee-for-Service (PFFS) Plans
These plans offer a wider degree of freedom in choosing your health care options. You can go to any doctor or hospital that accepts the plan. You may get extra benefits, such as additional days in the hospital
The coverage comes through a private insurance company. The company decides how much they pay for any given service and what portion you will pay.
Since the plan is handled through Medicare, you are eligible to receive Medicare’s coverage for prescription drugs, if drug coverage isn’t offered through the PFFS plan, or get that coverage through the PFFS plan.
If none of these solutions seem right for you, also review our Other Medicare Coverage Options >>
Request a free quote from carriers offering Medicare Advantage Products in your area >>
Return to the Medicare Advantage page >>
