Medicare Advantage Plans
What are Medicare Advantage Plans?
Regardless of whether it is an HMO or PPO plan, Medicare Advantage Plans work with medical professionals and facilities to offer coverage to beneficiaries. By relying on a network, policyholders have access to a team of medical professionals to provide care. Depending on which plan you select, you may have to choose a primary care physician to guide your care plan. It is important to understand the basics of both plans before making a decision. While both provide solid insurance plans, there are distinct differences between the cost, out-of-network coverage, size, and the process for seeing specialists.
HMO (Health Maintenance Organization) Basics
The first option available under the Medicare Advantage umbrella is the HMO plan, or Health Maintenance Organization plan. One of the biggest benefits when compared to PPOs is that the cost tends to be lower. Monthly premiums are less and the out-of-pocket expenses are smaller as well. With HMOs, a primary care physician will need to be selected once you enroll. This is the person that will coordinate your overall care plan and decide the treatment plan for you. You will also need to go through your PCP in order to get a referral to a network specialist. Since care is kept within the network it is highly unlikely you will ever need to file a claim after going to the doctors.
One drawback that many people are unaware of when they sign up is that the HMO does not cover out-of-network services. This means that if you have a current doctor who is not a part of the network then you would need to pay for services out of pocket unless you switched to a new care provider. The only exception to this being if you are having a medical emergency and can’t make it to a facility within the plan.
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PPO (Preferred Provider Organization) Basics
The second plan available with Medicare Advantage is the PPO plan, Preferred Provider Organization plan. Under this policy expect to have a little higher cost in the form of monthly premiums. One reason for the higher expense is that the PPO allows you to see care providers inside and out of the network without a referral from a primary care physician. There is also a chance that the out-of-pocket costs could be higher as well.
With PPOs, there is no requirement to get a primary care physician or get referrals to go see a specialist. This means that any doctors you have now you will still be able to go to even if they are not within the network of providers. However, there may be a slightly higher fee for seeing them and a separate deductible. Filing claims is another area you will need to complete with a PPO. There may be situations where you will need to pay a doctor directly then file a claim to be reimbursed at a later time.
Have Questions About Medicare Advantage Plans?
Deciding on a Medicare Advantage plan can be difficult when you have been with the same doctors for years, but can’t find coverage in your area. Let one of our experienced agents help you figure out a plan that will not only stay within your budget and keep you connected with the best medical professionals. To get started, give us a call today at 816-476-8191 for a free consultation.