Understanding Medicare Advantage Plan Types

When it comes to Medicare, it’s important to research coverage options to find a plan that works for you and provides the benefits you need. One of the most popular ways to obtain your benefits is through a Medicare Advantage plan, in part because there are many different types of coverage options available. The specific plan types available in our service area to look at are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). After gaining a basic understanding of how these Medicare Advantage options differ, you should compare plan costs, network and additional benefits to determine which one will work for you.

First, what is Medicare?

Medicare is the federal health insurance program that covers adults age 65 or older, select younger people with disabilities and individuals with End-Stage Renal Disease and Amyotrophic Lateral Sclerosis (ALS). Beneficiaries have the option to obtain their coverage through the federal government with Original Medicare (Part A and Part B) or through private insurance companies that provide Medicare Advantage plans. Depending on your decision, you may also seek to enroll in a Medicare Supplement plan and a Part D plan. While your medical coverage is standard across plans, additional benefits and costs are not. For example, while Original Medicare requires beneficiaries to pay 20% of many bills with no limit on out-of-pocket (OOP) spending, Medicare Advantage plans do provide out-of-pocket limits. Original Medicare will allow you to seek care from any provider that accepts Medicare where a Medicare Advantage plan will typically have a network component from which you can receive care. Choosing the right plan is essential to both your physical and financial well-being as you age, so here’s an overview of the different types of Medicare Advantage plans.

Health Maintenance Organization

Health Maintenance Organization (HMO) plans provide a primary care provider as well as a network of local doctors and hospitals to use for your health needs. HMO plans have low or $0 monthly premiums. If you’re enrolled in an HMO plan with a point-of-service (POS) option, you may have the option to go outside of the network for emergency services, but all your routine care will be accessed through the local or national network of providers. HMO plans will restrict your access to care through a provider network, though a current trend is plans offering access to their national provider networks. If you decide to enroll in an HMO Medicare Advantage plan, make sure your medications are covered and your pharmacy is a preferred in-network pharmacy to further reduce your costs.

Preferred Provider Organization

Preferred Provider Organization (PPO) plans can have low or $0 monthly premiums. However, PPOs, due to their inherent in and out of network design, provide more freedom in terms of obtaining services from health care providers. Medicare coverage under PPO plans include seeing any provider who participates in Medicare, not just in-network providers. Many PPOs have open access networks, so your in-network care does not require referrals. Your out-of-network care would be self-directed, but typically leaving you with a higher cost share.

It’s important to understand the basics of these Medicare Advantage plan types when you consider how your health and financial needs fit into your potential coverage options. Specifically, you should compare Medicare Advantage plans by cost, network and additional benefits. You can learn more here about how to select a Medicare Advantage plan in your area. To help you make the right choice for your current circumstances and evaluate your options every year to ensure your coverage suits your needs, contact Medicare Portal today. Our local Medicare insurance agents can offer you one-on-one assistance at no cost to you whenever you need!

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