Medicare Advantage Plans, also known as Medicare Part C, can fulfill the basic coverage that is offered by Original Medicare, but with additional benefits. Depending on the area you’re in, you might be able to enroll in one of the different types of Medicare Advantage plans, which includes HMO Plans, PPO Plans, PFFS Plans, SNP Plans, MSA Plans, and veterans health coverage.
All plans will offer the same amount of benefits but, of course, it ultimately depends on your area and plan providers. Basic benefits for each plan includes:
- Adult daycare services
- Dental, hearing, and vision
- Fitness memberships and wellness programs
- Nutrition programs
- Over-the-counter medications
- Services and support for those with chronic conditions
- Transportation to doctor appointments
Health Maintenance Organization Plans (HMO)
HMO plans require you to choose a doctor or hospital within the plan’s network in order to receive coverage. Because of this specific network, you’ll be paying a lower premium. Unless you’re in an emergency situation where you are admitted into a hospital outside of the plan’s network, you won’t receive coverage for going outside of the network. Also, if you need to see a specialist, your doctor will need to give you a referral.
Preferred Provider Organization Plans (PPO)
Just like HMO plans, PPO plans also have its own network of healthcare providers and hospitals, but you’re not required to use anyone with that network. However, if you stay within the network, you’ll pay less compared to what you would pay by going outside of the network.
While HMO and PPO plans may seem similar, there are a few differences involved with each plan. PPO plans will let you see doctors outside of their network, whereas HMO requires you to stay within their network and choose a primary care provider. You’ll also need a referral from your doctor if you need to see a specialist with your HMO plan. Because HMO is limited to their network, the premiums will be lower compared to PPO and their flexibility.
Private Fee-for-Service Plans (PFFS)
By having a PFFS plan, you don’t need to choose a primary care provider or receive a referral to see a specialist, which is similar to PPO plans, but it’s important to note you can see any doctor that agrees to accept the plan. You do have to be enrolled in Medicare Parts A and B in order to be eligible for PFFS. You’ll also be paying for both premiums of Part B and PFFS.
Medicare also sets the rates for how much they will pay for your healthcare provider and how much you’ll pay for the services. However, with PFFS, the insurance company you go through will set those rates.
Special Needs Plans (SNP)
Special Needs Plans that help serve those with unique needs, such as specific diseases or have a limited income. There are three types of SNPs:
- Chronic-Condition SNP: This plan is for beneficiaries who suffer from chronic conditions such as autoimmune diseases, cancer, End-Stage Renal Disease, and more.
- Dual-Eligible SNP: This plan is for beneficiaries who are receiving both Medicare and Medicaid benefits.
- Institutional SNP: This plan is meant for those who live in institutions, such as nursing homes, or need nursing care while at home.
SNPs may charge you a premium payment on top of the premium you’ll be paying for Medicare Part B. You also must get your medical services within the network, unless it is an emergency situation.
Medical Savings Account Plans (MSA)
Medical Savings Account plans use a high deductible health plan (HDHP), along with a bank account, to cover your healthcare costs. Because of the HDHP, you’ll be expected to pay a large deductible before receiving any coverage. The MSA plans will deposit money into an MSA account for your healthcare expenses and you can use the money to pay your deductible. However, you’re not allowed to deposit more money into the account. Once the money has been used up, you’ll be expected to pay out-of-pocket to pay off the rest of your deductible. MSA funds can only be used for qualified expenses and if misused you might be subject to income tax for unqualified expenses. Examples of qualified expenses include:
- Doctor or hospital visits
- Home Health Care
- Expenses that could be considered itemized deductions
While the Medicare Advantage plans offer all the same benefits, MSA plans are the only exception since they do not offer prescription drug coverage. To receive prescription coverage, you’ll need to join a Medicare Prescription Drug plan. You’ll also need to be enrolled in Medicare Parts A and B to be eligible for MSA plans.
Medicare Advantage for Veterans
If you are using TRICARE or Veterans Affairs (VA) health coverage, you are allowed to combine these services with Medicare. To do so, you have to already be enrolled in Medicare Parts A and B.
By combining your VA coverage with a Medicare Advantage plan, you can increase the amount of benefits you receive. For example, by enrolling with Medicare, you are not limited to receiving care from strictly VA facilities. You can receive care from outside the network. Also, VA isn’t set in stone for everyone, meaning that you could lose its coverage. By being enrolled with a Medicare plan, you’ll still be covered for your doctor and hospital appointments outside of the VA facilities.These types of plans are MA only and don’t cover prescriptions because veterans get theirs from the VA and don’t need a part D plan.
Looking to enroll with Medicare?
At Bobby Brock Insurance, we offer Medicare help for free, so reach out to us and book a free consultation today! If you have any questions regarding Medicare Advantage Plans or combining coverage, our well-trained and experienced agents are here to give you the answers you need. Give us a call at 662-844-3300.