Medicare Advantage plans, also known as Medicare Part C, cover additional things such as the following:
- Health and Wellness
- Coverage in Parts A and B.
- May also include Medicare Part D or prescription drug coverage.
Medicare pays a fixed amount for your plan every month to the companies offering Medicare Advantage plans. These companies must follow rules set by Medicare, however, each plan can charge a different out-of-pocket cost and have different rules for how to get services. These rules can change each year and not every plan is available in every county in Arizona. It’s important to review each option with a professional to ensure you get the plan that is right for you.
There are several kinds of Medicare Advantage Plans. Which type of plan you want may be influenced by the area you live in, your budget and your doctor preferences.
Health Maintenance Organization Plans (HMO)
A Health Maintenance Organization is a network of doctors and hospitals. In an HMO plan, you must use doctors who belong to the network or go to hospitals in the network for all of your care. If you go outside the network, except for emergency care, you must pay for your own care. With an HMO you choose a Primary Care physician. When necessary, he or she will refer you to a specialist.
PPO Point of Service Plan (HMOPOS)
A PPO Plan is a type of HMO plan that allows you the ability to use doctors and hospitals outside of the network for some covered services, usually for a higher co-payment or co-insurance. Some PPO plans do not require a referral to see a specialist which gives you the flexibility to see any doctor you wish, though it may be at a higher cost. Your maximum out of pocket will also be higher for both in network and out of network as compared to an HMO plan. Also, Your in network co-pays may be higher and some of the extra benefits may be lower than on a straight HMO plan.
Private Fee-for-Service Plans (PFFS)
A Private Fee for Service plan (PFFS), unlike HMO, POS or PPO plans, is not a network plan. You can see any doctor you wish as long as that doctor is willing to accept payment from the insurance company offering the plan. The doctor has the right not to treat you at any time, even if they have treated you previously. It is important to confirm that the provider accepts payment from your PFFS plan every time services are provided.
Special Needs Plans (SNP)
Special Needs plans are available for people who are eligible for both Medicare and the Medicaid assistance program, called AHCCCS. There are also special needs plan for those who live in an institution like a nursing home or other long-term care facility, or who have certain chronic diseases. These are Medicare Advantage plans. There are various Special Needs plans in Arizona but I can walk you through each one to find the best fit.
There are pros and cons to each Medicare Advantage Plan. Dee works with all the top carriers in the state and is happy to go through all these options in more detail. Please call (623) 251-6612 TTY: 711