Congress added Medicare Advantage plans to give Medicare participants more choices about how they receive their health care. That’s why you’ll find several different kinds of plans in this category.
[video=youtube;WCaTEDTelgY]http://www.youtube.com/watch?v=WCaTEDTelgY&feature=player_embedded[/video]
Medicare Advantage plans are all offered by private companies that have been approved by Medicare. To encourage competition, Medicare gives these private companies flexibility in setting the terms of each plan. That means you’ll find differences among plans as you shop.
Coordinated Care.
Medicare Advantage includes five kinds of plans. In three of the plans—Health Maintenance Organization Plans (HMO), Preferred Provider Organization Plans (PPO, and Special Needs Plans—your care is “coordinated.” That means the plan coordinates your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals. This is different from Medicare Part A and Part B, where you can visit any doctor or hospital that accepts payment from Medicare.
Private Fee-For-Service Plans and Medical Savings Accounts.
The other two types of plans—Private Fee-For-Service (PFFS) plans and Medical Savings Account (MSA) plans—do not use coordinated care. In these plans, you can get care from any provider willing to accept the terms, conditions, and payment rates each time they furnish covered services for you.
Choosing a Plan.
The majority of people who choose a Medicare Advantage plan select a coordinated care plan—an HMO, PPO, or Special Needs Plan. If you’re interested in a Medicare Advantage plan, you’ll need to do some homework before you make your choice.
Get a picture of the total cost. That means looking at both the premium (if any) you’ll pay to join and at your total estimated spending for cost sharing when you receive services.
You may also want to look for one of the Medicare Advantage plans that places a cap, or maximum, on your out-of-pocket spending. When you choose a plan, you should also consider whether a plan’s network (if it has one) gives you access to the doctors you want to see.
If you are looking for both prescription drug coverage and a coordinated care Medicare Advantage plan like an HMO or PPO plan, you will need to choose a coordinated care Medicare Advantage plan with prescription drug coverage built in. You can’t combine a standalone prescription drug plan with a coordinated care Medicare Advantage plan. You can, however, combine a standalone prescription drug plan with a PFFS plan or an MSA plan.
Shopping for a Medicare Advantage plan.
Start shopping by finding out what’s available in your area. You can find a list of the plans available at www.medicare.gov, or by calling the Medicare Helpline.
You can also get information about plans available to you from your State Health Insurance Assistance Program (SHIP).
Medicare’s list of plans includes contact information for each plan. You can call each plan you’re interested in and ask for more information.
If you have end-stage renal disease, there are some special rules for you. Contact the Medicare Helpline or your state Medical Assistance program for more information about your choices.
[video=youtube;WCaTEDTelgY]http://www.youtube.com/watch?v=WCaTEDTelgY&feature=player_embedded[/video]
Medicare Advantage plans are all offered by private companies that have been approved by Medicare. To encourage competition, Medicare gives these private companies flexibility in setting the terms of each plan. That means you’ll find differences among plans as you shop.
Coordinated Care.
Medicare Advantage includes five kinds of plans. In three of the plans—Health Maintenance Organization Plans (HMO), Preferred Provider Organization Plans (PPO, and Special Needs Plans—your care is “coordinated.” That means the plan coordinates your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals. This is different from Medicare Part A and Part B, where you can visit any doctor or hospital that accepts payment from Medicare.
Private Fee-For-Service Plans and Medical Savings Accounts.
The other two types of plans—Private Fee-For-Service (PFFS) plans and Medical Savings Account (MSA) plans—do not use coordinated care. In these plans, you can get care from any provider willing to accept the terms, conditions, and payment rates each time they furnish covered services for you.
Choosing a Plan.
The majority of people who choose a Medicare Advantage plan select a coordinated care plan—an HMO, PPO, or Special Needs Plan. If you’re interested in a Medicare Advantage plan, you’ll need to do some homework before you make your choice.
Get a picture of the total cost. That means looking at both the premium (if any) you’ll pay to join and at your total estimated spending for cost sharing when you receive services.
You may also want to look for one of the Medicare Advantage plans that places a cap, or maximum, on your out-of-pocket spending. When you choose a plan, you should also consider whether a plan’s network (if it has one) gives you access to the doctors you want to see.
If you are looking for both prescription drug coverage and a coordinated care Medicare Advantage plan like an HMO or PPO plan, you will need to choose a coordinated care Medicare Advantage plan with prescription drug coverage built in. You can’t combine a standalone prescription drug plan with a coordinated care Medicare Advantage plan. You can, however, combine a standalone prescription drug plan with a PFFS plan or an MSA plan.
Shopping for a Medicare Advantage plan.
Start shopping by finding out what’s available in your area. You can find a list of the plans available at www.medicare.gov, or by calling the Medicare Helpline.
You can also get information about plans available to you from your State Health Insurance Assistance Program (SHIP).
Medicare’s list of plans includes contact information for each plan. You can call each plan you’re interested in and ask for more information.
If you have end-stage renal disease, there are some special rules for you. Contact the Medicare Helpline or your state Medical Assistance program for more information about your choices.