Policy cover Choices for Medicare Entitled to Most people
Individuals with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans include HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO’s (Health Maintenance Organizations) which have been available because the 1980’s.
To help your parents (or you) make an informed decision, they need to know how these plans work, and then decide which plan is right for them. The next is just a brief description of each of the plan types.
If an individual elects to choose traditional fee for service Medicare, they could generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare has deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.
Medicare Advantage Plans (Part C)
If you opt to choose a Medicare Advantage Plan, you really trade your traditional Medicare benefits for these plans. Most of the Medicare Advantage Plans are offered to eligible individuals at minimum cost other than continued payment of the Part B monthly premiums.
Medicare HMO’s (Health Maintenance Organizations)
These plans cover exactly the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are appealing to Medicare eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits that are not covered by traditional Medicare.
Individuals considering a Medicare HMO should take note that they can only receive medical services from providers that are the main HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a key care physician from people who take part in their network. This primary care physician would then be responsible for all medical care including referrals to a specialist and admittance to a hospital. The HMO won’t purchase unauthorized visits to specialists nor non-emergency care received away from HMO’s service area or visits to non-network physicians.
These plans are private healthcare plans like HMO’s. However, PPO’s and HMO’s do differ into two essential areas. First, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals away from PPO network. And, second, Medicare PPO’s don’t usually require that you obtain an authorization before seeking care from the specialist.
Regional PPO’s can be purchased in many aspects of the country. These plans serve large geographic areas and must offer exactly the same premium costs and plan benefits to any or all individuals residing in these areas. Medicare PPO’s cover exactly the same types of medical expenses that traditional Medicare does. In addition, Medicare PPO’s commonly add a prescription drug benefit. Unlike traditional Medicare, Medicare PPO’s have an annual out of pocket limit for benefits covered under Parts Myaarpmedicare.com A and B of Medicare. The out of pocket limit caps the quantity an individual can spend on covered medical expenses in a calendar year. Much like any PPO program, when an individual works on the non-contracted provider for covered services, they will pay more out of the pocket.
These plans are available to Medicare beneficiaries as a swap due to their traditional Medicare Benefits. PFFS don’t have a proper network of doctors and hospitals to pick from and not totally all doctors or hospitals are willing to offer medical services to participants in these types of plans. If an individual is considering enrollment, it is wise to check on using their doctor and local hospitals to be sure that they will accept the plan’s payment for services before enrolling. Also, the enrollee should thoroughly understand the advantages of a fee for service plan since the fee for service plans decide how much they will purchase Medicare covered services and may charge an increased cost sharing percentage than traditional Medicare. Private fee for service plans may add a prescription drug benefit. If they cannot, the enrollee is free to participate a Medicare stand alone prescription drug plan.
These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help spending money on their medical benefits. These would include folks who qualify for both Medicare and Medicaid (MediCal in California), those residing in long term care facilities, and people that have chronic or disabling medical conditions.
Prescription drug plans are available to any or all Medicare eligible persons irrespective of medical history or income levels. Whenever a person first qualifies for Medicare, their initial enrollment period begins 3 months before their 65th birthday, includes their birth month, and ends 3 months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on the following January 1st.
Medicare drug plans are created to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there’s a monthly cost for these plans. In addition to a monthly premium, the covered individual is required to pay a share of the price of the medications (or a copay) and Medicare pays the main cost. Costs for an idea will be different depending on the medications taken and the type of plan selected. At least, the plans available must provide a “standard” degree of coverage.
Individuals with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans include HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO’s (Health Maintenance Organizations) which…