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Understanding Medicare Advantage Plans

Posted by on 22 Jan, 2016

Disease or accidents can strike at any time, making it important to prepare for the costs of unexpected medical services. Medicare Advantage Plans are an option for patients 65 or over who are looking to manage healthcare costs.  A type of Medicare health plan, Medicare Advantage plans are operated by private companies.

Many different types of Advantage Plans are offered, carefully designed to suit a variety of needs. Participants can choose any one of them to make sure the appropriate coverage is received.

MEDICARE ADVANTAGE PLAN OPTIONS

  • Health Maintenance Organization Plans (HMO)
    HMO plans restrict healthcare visits to a specific doctor, hospital or other provider that is listed as an option by the plan. Emergencies, out-of-area urgent care and out-of-area dialysis are the only exceptions to this limitation. In most cases, it is necessary to get referrals from a selected primary doctor. Prescription drug coverage is generally offered, but availability should be confirmed before signing-up for a plan. Caution: If care is sought outside of the network or without proper approval, the patient may be responsible for full costs.
     
  • Preferred Provider Organization Plan (PPO)
    Patients pay less with a PPO when doctors, hospitals, and other health care providers are used that belong to the plan's network. PPOs offer the flexibility to use a provider outside of the network however out-of-network services generally cost more.
     
  • Special Needs Plan (SNP)
    Limited to people who have disabilities or specific diseases, SNPs tailor benefits and provider choices to fit the specific needs of the patients in the group they serve. All SNP plans provide prescription drug coverage.
     
  • Medical Savings Account (MSA)
    Offering two reverse medical aids, Medicare works with private insurance companies to ensure that treatment may be received from any doctor or hospital. A high-deductible health plan will only begin to cover healthcare costs once a high yearly deductible is met. Deductible levels vary by plan. The second part of an MSA plan is a special type of savings account. Money is deposited into the patient's account. These monies may be pulled to pay health care costs before meeting the deductible.
     
  • Private Fee-for-Service (PFFS)
    This plan establishes in advance how much it will pay doctors, other health care providers, and hospitals, and determines how much you must pay when you receive care. 

ADVANTAGE PLAN ELIGIBILITY

Anyone can join Medicare Advantage Plans if they fulfill a range of conditions. First, patients must be residing in the service area of the plan they wish to join. More information about service areas is available on the website: http://www.medicare.gov. Secondly, participation in Medicare Plan A and Plan B is required. Lastly, patients in End-Stage Renal Disease (ESRD) are ineligible to join.

HOW TO ENROLL

Before joining a Medicare Advantage Plan, the various available options should be considered. Requesting quotes can be a key aid in the decision making process. Medicare’s Plan Finder (https://www.medicare.gov/find-a-plan/questions/home.aspx) offers assistance in selecting the suitable plan.  A phone call or visit to the individual plan’s website can help to determine additional steps to finalize enrollment.

Selecting a Medicare Advantage Plan may seem a daunting task, but the time analyzing and selecting can prove to be well worth the investment.  In the event an urgent care visit is necessary, Urgent Clinics Medical Care is pleased to accept Medicare Advantage Plans at all of our conveniently located facilities in Pearland, Champions, The Woodlands and 3 locations in League City: Creekside, Marina Bay and Tuscan Lakes.

 

 

 
 
 
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