Types of Medicare Advantage Plans
The following information provided by PayingforSeniorCare.com , an organization striving to access reliable and up-to-date information about financial resources for seniors…
Medicare Advantage, also known as Medicare Part C, is provided separately by both private insurance carriers and the federal government. Private Part C plans may include benefits not paid for by Original Medicare, such as vision, dental and prescription drug coverage.
Roughly 34% of Medicare-eligible elders choose to participate in some type of Part C plan. Rates of participation vary significantly by state. For example, in Massachusetts, 21% of older adults have enrolled in a Part C plan to receive their Medicare benefits, which puts Massachusetts 35th in the nation overall for Medicare Advantage participation.
Eligible seniors may enroll in Medicare Advantage through one of four basic plan types: HMO, PPO, PFFS, and SNP. It’s important to diligently research each option to determine which one offers the ideal coverage and cost.
— Health Maintenance Organizations: HMOs… provide coverage for medical services like any other insurance plan, but the services are mostly delivered by one large organization. Doctors, nurses and other health providers are generally employees of the HMO, and members must seek care from the organization’s provider network. Beneficiaries typically need clearance from their network primary care physician before seeking specialist services, but monthly premiums tend to be lower with HMOs than other plan types.
— Preferred Provider Options: PPOs…In many ways, PPO plans operate much like HMOs, but there tends to be more flexibility in how benefits are delivered. Members of PPO plans usually pay a little more for monthly premiums than HMO plan members, but beneficiaries can often choose from a larger pool of care providers. Unlike with an HMO, PPO providers are not employees of the insurer, but they are grouped into a plan network of independent providers who contract with the PPO to provide care to plan members. PPO members can usually seek care outside of the network, although the plan may pay the provider less for the service.
— Private Fee-for-Service: PFFS…plans operate much like fully private insurance policies. Members are free to seek out medical care anywhere they wish, and providers may or may not accept the PFFS plan for payment. Providers that do not accept the insurance company’s terms may bill the plan member at private-pay rates. PFFS plans are very flexible in how services are delivered, but they tend to charge high monthly premiums.
— Special Needs Plans: SNPs are designed to focus on member benefits for specific health issues, often by reducing coverage in other areas or by charging high monthly premiums. SNPs are often preferred by beneficiaries with diabetes, physical disabilities and other chronic health conditions, since an SNP designed to meet their needs can often be the most efficient way to pay for dialysis, physical therapy or the other specific services a chronic condition requires. Though the monthly cost of a SNP is generally above average for a Part C plan, needs-specific care can be available at significant cost savings for beneficiaries who qualify for this type of coverage. Seniors who have been diagnosed with renal failure are an exception to the general SNP eligibility rule, as this condition is covered directly by Original Medicare benefits.
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John D. Miller is the founder/owner of Home Care Partners, LLC, a Massachusetts business providing private duty, personalized in-home assistance and companion care services to those needing help in daily activities and household functions.
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