People with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans include HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, most are enrolled in HMO’s (Health Maintenance Organizations) which have been available because the 1980’s.

To greatly help your parents (or you) make an informed decision, they need to know the way these plans work, and then decide which plan is right for them. These is a brief description of each of the plan types.

Original Medicare
If an individual elects to opt for traditional fee for service Medicare, they can generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare has deductibles, copays and cost sharing requirements that can play havoc with budgets. To greatly help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.

Medicare Advantage Plans (Part C)
In the event that you prefer to opt for a Medicare Advantage Plan, you actually trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are given to eligible individuals at little or no cost other than continued payment of their Part B monthly premiums.

Medicare HMO’s (Health Maintenance Organizations)
These plans cover exactly the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are attractive to Medicare eligible individuals since they often provide extra benefits like eyeglasses, hearing aids, and dental benefits that are not covered by traditional Medicare.

Individuals considering a Medicare HMO should bear in mind that they’ll only receive medical services from providers who’re the main HMO’s network of contracted providers. The HMO usually requires that the individual joining their plan select a key care physician from those that participate in their network. This primary care physician would then result in all medical care including referrals to a specialist and admittance to a hospital. The HMO won’t pay for unauthorized visits to specialists nor non-emergency care received beyond your HMO’s service area or visits to non-network physicians.

These plans are private healthcare plans like HMO’s. However, PPO’s and HMO’s do differ into two essential areas. First, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals beyond your PPO network. And, second, Medicare PPO’s don’t usually require that you obtain an authorization before seeking care from the specialist.

Regional PPO’s can be found in many areas of the country. These plans serve large geographic areas and must offer exactly the same premium costs and plan benefits to all or any individuals residing in these areas. Medicare PPO’s cover exactly the same kinds of medical expenses that traditional Medicare does. In addition, Medicare PPO’s commonly include a prescription drug benefit. Unlike traditional Medicare, Medicare PPO’s have an annual out of pocket limit for benefits covered under Parts A and B of Medicare. The out of pocket limit caps the quantity an individual can spend on covered medical expenses in a calendar year. Just like any PPO program, when an individual uses a non-contracted provider for covered services, they’ll pay more out of their pocket.

These plans can be found to Medicare beneficiaries as a swap because of their traditional Medicare Benefits. PFFS don’t have an official network of doctors and hospitals to choose from and not totally all doctors or hospitals are willing to supply medical services to participants in these types of plans. If an individual is considering enrollment, it is wise to check on with their doctor and local hospitals to be sure that they’ll accept the plan’s payment for services before enrolling. Also, the enrollee should thoroughly understand the benefits of a fee for service plan because the fee for service plans decide simply how much they’ll pay for Medicare covered services and may charge a greater cost sharing percentage than traditional Medicare. Private fee for service plans may include a prescription drug benefit. If they don’t, the enrollee is free to become listed on a Medicare stand alone prescription drug plan.

These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help investing in their medical benefits. These would include individuals who qualify for both Medicare and Medicaid (MediCal in California), those residing in longterm care facilities, and those with chronic or disabling medical conditions.

Prescription drug plans can be found to all or any Medicare eligible persons regardless of medical history or income levels. Each time a person first qualifies for Medicare, their initial enrollment period begins three months before their 65th birthday, includes their birth month, and ends three months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on these January 1st.

Medicare drug plans are created to reduce drug costs for enrollees and drive back catastrophic drug costs. However, there is a monthly cost for these plans. In addition to a monthly premium, the covered individual is required to pay a percentage of the price of the medications (or a copay) and Medicare pays the main cost. Costs for an agenda will vary with regards to the medications taken and the type of plan selected. At a minimum, the plans available must supply a “standard” amount of coverage.

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