Medicare Advantage Plans – Types and their features

Medicare Advantage Plans – Types and their features

Investing in a health insurance plan is important. It is wise to take precautions when it comes to unexpected health situations. An alternative to the government insurance, Medicare, Medicare Advantage is private insurance. They are beneficial for several reasons – they offer long-term savings, pay for additional medical expenses, allow more flexibility, and often assure better care.

Medicate Advantage Plans combine the advantages of the original Medicare plans A and B and augment that with several other benefits like hospitalization fees, home healthcare services, dental, prescription drugs, preventive care, and even SilverSneakers fitness memberships.

Types of Medicare Advantage plans
The following are the six major types of Medicare Advantage plans and their features.

Health Maintenance Organization Plans
Health Maintenance Organization, or HMO, covers health care services provided by a defined network of professionals. It is the most popular Medicare Advantage Plan with over 16 million enrollments. While there is a limitation on which health care professionals you can pick, your out-of-pocket expenses are the lowest in the market. In emergencies, you need not adhere to the strict network of health care providers. But if you wish to expand the options, you will be paying entirely from your pocket. However, be aware that there are many subtypes to the HMO plan. So you most certainly will be able to ensure you get the best medical treatment and care.

Preferred Provider Organization Plans
Preferred Provider Organization or PPO plans are a type of Medicare Advantage plan that charges less for using health care providers within the prescribed network. One-third of the 26 million Americans with Medicare Advantage Plans have a PPO plan. Depending on the subtype of the plan you choose, you may or may not have an annual deductible. The out-of-pocket costs will be higher than the HMO plan, but this price earns you flexibility, allowing you to see a more extensive range of doctors. You won’t have to seek referrals to consult specialists. You receive the most benefit when you ensure your preferred professionals are also on the plan’s list of preferred providers.

Private Fee-For-Service Plans
Private Fee-For-Service (PFFS) is one of the more uncommon among the Medicare Advantage Plans. These may or may not prescribe a network of providers and accept non-network providers who accept Medicare reimbursement and the plan’s terms and conditions. It means you need to ensure, probably in advance, that your doctor or hospital will accept these terms and conditions. The limited number of such individuals and organizations makes it one of the less preferred plans. Further, the plan does not cover prescription drugs, thus increasing your expenses.

Special Needs Plans
Special Needs Plans or SNPs are tailor-made for individuals with chronic conditions. The 4 million individuals enrolled in these Medicare Advantage Plans need to qualify for Medicare and Medicaid to obtain services. These plans are typically not chosen by the enrollees but referred by your healthcare service provider. If you have dual eligibility for Medicare and Medicaid, have a chronic or disabling medical condition like diabetes, or live in a nursing home, you are eligible for an SNP.

Medical Savings Account
Medical Savings Account or MSA is one of the less common Medicare Advantage Plans. It offers a high-deductible with a dedicated savings account. Medical care expenses are deposited into the designated account, usually every month. Note, however, that MSAs do not pay for prescription medication.

HMO Point-of-Service
HMO Point-of-Service (HMO-POS) is another seldom-used type of Medicare Advantage Plan. A hybrid Health Maintenance Organization plan allows you to go outside the prescribed network of healthcare professionals for a higher cost. There are separate deductible rates for in-network and out-of-network charges, making payments rather complicated.

Remember to consult your trusted physician and ensure they are part of one of the types of Medicare Advantage Plans or are willing to agree to their terms and conditions so that you can continue with the healthcare provider of your choice. Do not make hasty decisions regarding health care. Consider your options wisely, and then call an agent to clarify doubts before filling out an application.

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