MEDICARE ADVANTAGE PLAN AND ITS TYPES

Medicare Advantage plan is an alternative way to get your Medicare coverage. It is provided by private health insurance companies, Medicare-approved, wherein it consists of all Part A, Part B and Part D of your Medicare. 

It is a bulked plan in which you can enjoy extra benefits than that of the original Medicare. However, you are only able to use medical practitioners or health care institutions who are part of this plan’s network and service area but for a lesser cost. And in order to protect you from unexpected costs, this plan will set a limit on your maximum expenditures for the whole year for the covered services. 

There are actually various types of Medicare Advantage plans and some common plans are listed as follows:

Health Maintenance Organization (HMO)

In Health Maintenance Organization plans, you are only allowed to get your services from the providers of the plan network except in cases of emergency care, out of area urgent care, and out of area dialysis. But in normal cases, it really is advisable to just go to your network provider to enjoy your plan with a lesser cost through HMO point of service (POS).

Other things you need to know about this plan is that when a health care provider or you physician leaves the plan, you will be right away notified and can choose different doctor but still under the network. It is also important that you follow the rules set by this plan like getting an advanced approval for the services needed. It should also be noted that once you get health care outside of this plan, you may have to be liable to pay its full cost.

Special Needs Plans (SNP)  

Medicare Special Needs Plan limits its membership to people who have specific medical conditions. These includes people who live in nursing homes, who require nursing care at home, people who are entitled to both Medicare and Medicaid, and people who have chronic diseases like diabetes, HIV/AIDS, ESRD (End-Stage Renal Disease), chronic heart failure, or dementia. Medicare SNP requires members to get their care only to the doctors or hospitals who participates in the network except if there is an urgent need for medical care. 

Private Free-for-Service (PFFS) Plans

Unlike ordinary Medicare or Medigap, PFFS plan will determine how much you need to pay for the doctors and health care providers when you get the care. You can however get your medical needs on any Medicare-approved doctor or health care provider under this plan but if you joined in a network then you must follow their rules to incur less cost. 

Preferred Provider Organization (PPO)

Just like other Medicare Advantage plans, you’ll incur lesser cost if you stick to the doctors or hospitals provided under this network and will pay more if you seek health care to providers outside this network. Because providers here are preferred, you can save a lot by using them. Anyhow, since it offers extra benefits than that of the original Medicare, you may also have to pay for those extra benefits.