Medicare Advantage plans are health insurance plans that are offered by private companies to people who are eligible for Medicare. These plans offer all of the benefits of original Medicare, plus extras like vision, dental, hearing coverage, and more.
There are many different types of Medicare Advantage plans, so here we’ll discuss everything you need to know about these plans before enrolling, as well as where you can go in Lakeland and throughout Central and South Florida to see a doctor who accepts Medicare Advantage plans.
What Is a Medicare Advantage Plan?
A Medicare Advantage plan, also known as a Medicare Part C plan, is a health insurance plan offered by private companies that have a contract with Medicare. These plans cover everything that original Medicare Part A and Part B cover, but they also cover additional medical services.
Almost all of the big-name private insurance companies – like Blue Cross Blue Shield, Aetna, and United Healthcare – offer Medicare Advantage plans in addition to regular commercial health plans. Some private insurance companies offer only Medicare Advantage plans.
There are many options to choose from, so it is important to look at all the benefits and focus on the ones that best match your needs and your finances when selecting a plan.
Different Types of Medicare Advantage Plans
Although Medicare Advantage plans vary by private insurer, there are generally four plan types: Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service plans, and Special Needs Plans.
Health Maintenance Organizations (HMOs)
Health Maintenance Organizations require you to see doctors and other healthcare providers that are in the plan’s network, otherwise you will have to cover the full cost out-of-pocket. If you need to see a specialist, you will usually need to get a referral from your primary care doctor.
If you see a healthcare provider who is outside of your plan’s network, or if you did not get a referral before seeing a specialist, you may have to pay the full cost. If you need Medicare drug coverage (Part D), be sure to join an HMO plan that includes it (most do), as these plans do not allow you to join a Part D plan separately.
Preferred Provider Organizations (PPOs)
Preferred Provider Organizations also have a network of doctors and other healthcare providers, but you are still somewhat covered if you see out-of-network providers – although this usually costs more than seeing in-network providers. Another benefit of a PPO over an HMO is that you may not have to get a referral from your primary care doctor before you can see a specialist. Like HMO plans, medication coverage is included in most PPO plans, and you cannot join a separate Part D plan.
Private Fee-for-Service (PFFS)
Private Fee-for-Service plans are different from HMOs and PPOs in that the insurance company determines how much it will pay the healthcare provider and how much it will charge the plan member, instead of Medicare determining these costs. In addition, healthcare providers who are not in-network can choose to provide services to a patient at the rate stipulated by the PFFS plan on a case-by-case, patient-by-patient basis.
It is very important to show your PFFS insurance card each time you receive treatment or otherwise receive medical care. Make sure that the doctor accepts the terms of the plan before the appointment. Because of this flexibility, it is possible for a doctor you have seen before to refuse treatment or to decline the terms of the plan.However, in all emergency situations, healthcare providers must treat you by law.
Prescription drugs are covered in some PFFS plans, but if they are not covered by the plan you choose, you may enroll in a separate Medicare drug plan (Part D). This is different from Medicare Advantage HMOs and PPOs, which do not allow separate enrollment in Part D.
Special Needs Plans (SNPs)
Special Needs Plans are only for people who have specific health conditions or living circumstances. To qualify for an SNP plan, you must fall into one of the following categories:
- You live in a nursing home or require nursing care at home
- You are eligible for both Medicaid and Medicare
- You have a chronic or disabling health condition like dementia, end-stage renal disease, HIV/AIDS, or chronic heart failure
SNPs generally resemble HMO plans. Most SNP plans require you to choose a primary care doctor, and you need to get a referral before seeing a specialist.
All SNPs provide prescription drug coverage under Medicare Part D. Some SNP plans cover out-of-network services, and some don’t.
How to Choose the Right Plan for You
There are many factors to consider when choosing a Medicare Advantage plan, including the benefits offered, the cost of premiums and co-pays, and whether the plan covers the doctors and healthcare providers you want to see.
Medicare Advantage plans have many benefits, including coverage for services like vision, dental, and hearing. They also typically have lower out-of-pocket costs than original Medicare.
However, there are some drawbacks to these plans as well. For example, not all Medicare Advantage plans cover prescription medications.
Considering all this, it is very important to take time and think carefully when choosing the right Medicare Advantage plan for you.
Doctors Who Accept Medicare Advantage Plans in Lakeland, FL
If you’re looking for a doctor who accepts Medicare Advantage plans in Lakeland, Florida, then Palm Medical Centers is here for you. We have two locations in Lakeland – one in North Lakeland and one in South Lakeland – for your convenience.
All of our doctors are in-network with most Medicare Advantage plans, including Humana, Aetna, Preferred Care Partners, Preferred Care Network, Wellcare, Simply Healthcare, Optimum, and much more. In addition, we offer free unlimited transportation to and from medical appointments for all our Medicare Advantage patients. This includes transportation to specialists outside of our centers when necessary, as well as daily transportation to our wellness centers for wellness activities.