A Beginner’s Guide to Medicare Advantage Plans

Jessica Haase Medicare, Uncategorized

The phone rings, you look at the caller ID to discover that it’s your daughter again. You roll your eyes because you know she is going to hound you for not signing up for Medicare. You answer the phone and continue to get lectured for 30 minutes. Finally, you hang up the phone and decide to sit down at the computer and do some research. You type Medicare into Google and realize there is a ton of information to sift through. Since you already understand the basics of Medicare you start looking at Medicare Advantage Plans, then become lost.

As you start looking at different Medicare Advantage plans it’s important to know that there are many different types to choose from. Listed below are some different plans and what they offer. Keep in mind some plans may work better than others. It depends on your specific situation. It can be difficult to determine which one would be the best fit.

Health Maintenance Organizations (HMO)– A HMO is very network centric. With an HMO you can only go to doctors that are in your network. If you go to a doctor outside of your network, you will have to pay the full price of the visit. Most HMO plans do offer prescription coverage. If you are wanting Medicare prescription drug coverage (Part D) you must choose an HMO plan that includes that coverage as well. So remember, HMO is all about the network.

Preferred Provider Organization (PPO)– With this  plan you will pay less for seeing a doctor inside your network. If you choose to see a doctor outside of the network, you will pay more. The difference between an HMO and PPO is that with a PPO you still have the option of going to a doctor outside of the network, you will just have to pay more. With an HMO you do not have that option at all. You would have to pay 100% out of pocket if you went outside of the network. The PPO plans are more flexible and will give you more wiggle room when choosing a doctor or hospital.

Private Fee-For-Service (PFFS)-With this type of plan you may or may not have a network. The cost is determined up front and the plan will pay out an exact amount to doctors, health care providers, and hospitals. It is also pre-determined how much you will pay when you receive care. If you do choose a PFFS plan with a network, that means that all of those health care providers agreed to the PFFS conditions. The PFFS plans are more about the bottom line. Basically, this is how much they will offer, and this is how much you will pay, no questions asked.

Medicare Medical Savings Account (MSA)– This type of plan is very similar to the Health Savings Account Plans available through regular health insurance. This plan tends to be more flexible with the doctors that you choose. There are two parts to an MSA plan. The first part consists of a high deductible. This means that the insurance will not start covering your health care costs until you reach the yearly deductible. The second part of the plan is a savings account. You can deposit money into the account then use those funds to cover your health care costs before you reach your deductible. The MSA Plans were created to give you more control over your health care coverage by providing the savings account.

As you can see there are many plans to choose from when picking a Medicare Advantage Plan. It’s always best to consult with an agent to make sure you qualify for the plan, and ensure that the plan is the best fit for your needs. If you have any questions or would like to speak to an agent give us a call at (615)-541-4257 and we would be happy to help you.