Understanding Medicare Benefits

Understanding Medicare Benefits

Medicare Advantage (formerly Medicare + Choice) is a program through which the Medicare population can receive benefits with a private insurance plan and quotes can be found on https://www.medicareadvantageplans2020.org so check it out. The government pays insurers a set amount to cover a portion of the plan, while insurers may offer a variety of other benefits (and some other costs) in accordance with rules set by the Center for Medicare and Medicaid Solutions. In many cases, prescription drug coverage (Medicare Part D) is included in best Medicare Advantage plans.

Plan Types

Preferred Provider Organization (PPO): Some Medicare Advantage plans hire a network of healthcare providers (e.g. hospitals, doctors) and charge less when participants use their services. Plan participants may use external providers for an additional charge.

Health Management Organization (HMO): HMOs also have a network of pre-approved service providers that will be covered under your plan. However, the main difference is that you must choose a primary care physician. This primary care physician acts as your personal physician, but also as your health care coordinator. If you need to see a specialist doctor who was not in your health plan network, your primary care doctor may offer referral if you need it. With this reference, your insurance will cover some of the costs, but without it you will be able to pay the full price.

Private Service Pay (PFFS): PFFS plans act very similarly to traditional Medicare, in that you can see any provider who accepts the payment arrangements for your plan. Sometimes these plans establish supplier networks for certain categories of services, but allow you to see someone outside the network who accepts payment for the plan.

Special Needs Plan (SNP): Special needs plans are available to members of the Medicare-eligible population who are also Medicaid-eligible, institutionalized or have a chronic condition.

Medical Savings Accounts (MSA): Medical savings accounts usually do not require a premium as they have a high deduction. Participants must pay the Medicare Part B premium and also pay for services covered by Medicare. Once a participant reaches the deductible, the plan will pay for Medicare services. Medicare also deposits money into a savings account to pay for medical costs. MSA plans do not include prescription drugs, but you can often buy an independent prescription drug plan. Medicare Advantage is beneficial because it usually does not require the purchase of a Medicare Supplement Plan and usually offers additional benefits such as dental and vision coverage, or “wellness” benefits such as discounts at gym memberships. Participants who choose to enroll in Medicare Advantage maintain all Medicare regular patient protections and have the right to enroll in the Medicare and Medicaid Service Center.

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