PPO | HMO | Medicare Advantage | MA-PD Plan

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Medicare Advantage Insurance Plans
The federal government has coordinate with private insurance companies to coordinate an option in the Medicare program known as Medicare Advantage Plans (MA) that coordinates Medicare Part A and Medicare Part B. Participants choosing to enroll in Medicare Advantage basically assign their Medicare benefits over to the plan.
What this does is allow the insurance companies to coordinate Medicare benefits on your behalf. Medicare Advantage Plans are more all inclusive than Medicare Part A and Medicare Part B. Most MA plans include prescription drug coverage which is only available to Medicare Part A and B participants by purchasing Medigap Plan D supplemental insurance plan.
Enrollees that choose Medicare Advantage are required to take the prescription drug coverage that is offered with their plan. Participants are not allowed to sign up for separate Medicare Medigap insurance plans when they are enrolled in MA Plans.
Depending on the Medicare Advantage Plan that has been chosen the doctors and hospitals that participants can see are limited. The coverage is dependent on the plan that is chosen and the network of doctors and hospitals within the plan.
3 Main Medicare Advantage Plans
Here is a brief description of how each type of Medicare Advantage Plan works. Participants need to check with the individual plan offering for details and exceptions:
Medicare Health Maintenance Organization (HMOs): With an HMO enrollees must get care from their primary care doctor, specialists, or hospitals within the plan’s network except for emergency situations.
Medicare Preferred Provider Organization (PPOs): With a PPO enrollees can visit any physician regardless of their participation in the plan’s network. If they choose to see primary care doctors, specialists, and hospitals in the plan’s network they will pay less than those outside of the plan’s network.
Medicare Private Fee For Service (PFFS) Plans: Enrollees in this plan can see any primary care doctor, specialist, or hospital that follows the terms of the plan’s payment.
Medicare Advantage Costs
The premium that participants will pay for Medicare Advantage Plans depends on the plan that they choose. It is their responsibility to not only pay the premium but any applicable deductibles, co-pays, and/or coinsurance.
One of the nice features of the Medicare Advantage program is that they have a “maximum out of pocket” expense. This puts a limit on the overall total amount of money that participants are liable for within a year.
Medicare Advantage Coverage
The MA-PD plan integrates both medical and prescription drug coverage. The services covered in Medicare Advantage are all the same as what is seen in Medicare Part A and Part B along with additional benefits that create complete, all inclusive health insurance plans.
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Author: Victoria