Even though Medicare Advantage plans are run by private companies, there are many federal safeguards built into them, such as being required to cover everything that is included in the Original Medicare coverage.
A person who has Medicare Part A and Part B and lives in the service area of the plan they want to join is eligible to join a Medicare Advantage plan. It’s just a matter of choosing the plan that best suits your needs.
Choosing the right Medicare plan can seem like a complex and daunting task, especially when it comes to understanding the advantages – and potential disadvantages – of different types of Medicare Advantage plans. To help simplify the process, here are some things you ought to know about Medicare Advantage plans.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans from which to choose. The most common plans are:
- Health Maintenance Organization (HMO) plans – With an HMO plan, you need to select a primary care physician (PCP) who is in the plan’s network. If the services of a specialist are required, your PCP will provide a referral. However, certain services (e.g., annual mammograms) do not require a referral, while other services, such as out-of-area dialysis, may not be offered. In most cases, prescription drugs are covered under an HMO plan. Under some HMO plans, you may be able to go out of network for certain services, but you’ll likely pay the full cost.
- Preferred Provider Organization (PPO) plans – Like HMO plans, PPO plans have a network of doctors, other healthcare providers, and hospitals that you can use to pay less. The difference is that you don’t have to choose a PCP or obtain a referral to see a specialist. In most cases, prescription drugs are covered, but you should confirm this before joining a PPO plan. If it doesn’t, you cannot join a Medicare prescription drug plan (Part D).
- Private Fee-for-Service (PFFS) plans – This type of Medicare Advantage plan determines how much it pays doctors and hospitals for your care, and how much you must pay. You don’t have to choose a PCP or obtain a referral to see a specialist. You can use any of the network providers who have agreed to treat PFFS plan members or choose an out-of-network doctor or hospital that accepts the PFFS plan’s terms. However, your costs will probably be higher. Plus, Original Medicare (Parts A & B) will not pay for your health care while you’re on a PFFS plan. If the PFFS plan doesn’t offer drug coverage, you are allowed to join a Medicare prescription drug plan (Part D).
- Special Needs Plans (SNPs) – This is a Medicare Advantage plan that limits membership to people with specific severe and chronic conditions, such as autoimmune disorders, cardiovascular disorders, cancer, diabetes mellitus, end-stage liver, and renal disease, HIV/AIDS, chronic lung disorders, neurologic disorders, and stroke, just to name a few. Care and services are provided by doctors or hospitals in the SNP network. Medicare prescription drug coverage is provided, and you are usually required to have a primary care doctor and a referral to see a specialist except for certain OB/GYN services.
- Medicare Medical Savings Account (MSA) plans – An MSA is intended to help self-employed individuals and employees of small businesses save and pay for medical expenses not covered by health insurance. A Medicare MSA plan combines a high-deductible insurance plan with a medical savings plan to pay for health care costs, covering most of the services that Medicare Advantage plans cover with the exception of Medicare Part D prescription drugs. Some MSA plans also cover certain services – such as dental, vision, and long-term care not covered by Medicare – for an extra cost.
The rules for Medicare Advantage plans can change each year, so be certain to review your plan annually.
Medicare Health Services for Seniors in Central and South Florida
Choosing and enrolling in the right Medicare Advantage plan can be a challenging process. Fortunately, you don’t have to deal with it alone. As a provider of senior-focused healthcare services in Florida, we at Palm Medical Centers believe you and your loved ones should receive all the assistance you’re entitled to. That’s why we have dedicated patient relations outreach representatives who work with ACCESS Florida representatives to streamline the process for you.
In addition to providing comprehensive medical care for our patients, we also help them access and obtain social service assistance related to:
- Medicaid application and renewal
- Medicare application and plan selections
- SNAP (Supplemental Nutrition Assistance Program) and meal assistance
To discover all the benefits of becoming a patient at Palm Medical Centers, call us today at (833) 500-PALM (7256) or send us a message now. For your convenience, we have 22 clinics throughout Central and South Florida. We look forward to serving you and your family.