Medicare Advantage plans, or Medicare Part C, were created to include all the different parts of Medicare plans, such as Part A, Part B, and sometimes Part D. Many Medicare Advantage plans are inexpensive due to low premiums, but some are restrictive when choosing your provider network.
Choosing A Doctor With Medicare Advantage
In most cases, you will be required to choose a doctor within your Medicare Advantage plan’s network and service area to ensure the lowest cost possible. Some plans will refuse to cover any services received from an out-of-network provider. You may also need a referral from your physician to seek treatment from a specialist.
Different Types of Medicare Advantage Plans
Medicare Advantage plans offer multiple plan options, such as:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-For-Service (PFFS) plans
- Special Needs Plans (SNPs)
- Medical Savings Account (MSA) plans
HMO plans provide you with coverage for health services and care as long as the physician, other health care providers, or hospitals are within the HMO network. The only coverage exceptions are emergency care, out-of-area urgent care, or out-of-area dialysis.
PPO plans have a network of physicians, other healthcare providers, hospitals, and specialists available for you to choose from in your plan’s network. If you choose from this list, you will pay lower out-of-pocket costs for treatment and services. PPO plans do allow you to receive care from out-of-network providers as well, but your out-of-pocket cost will be higher due to your treatment or service not being in the “preferred” network.
If you enroll in a PFFS plan, then you can seek treatment and services from any Medicare-approved physician, other healthcare providers, or hospitals that accept your plan’s terms and conditions. Some PFFS plans have a network to choose from, providing you with a list of approved treatment and service providers. You also have the option to seek treatment from a doctor that is out-of-network but still accepts your plan’s terms and conditions. If you choose to do so, your out-of-pocket costs will be higher than if you received treatment or service from an in-network provider.
SNPs tailor their options to best suit the individual’s needs. An SNP is either an HMO or a PPO plan. Services covered by Medicare Part A and Part B under Medicare Advantage plans are also covered, plus extra depending on the needs of the Medicare enrollee. If you have an SNP, you must use the providers in your plan’s network.
An MSA plan combines a high-deductible and medical savings account to pay for your health care expenses. This type of plan usually does not have a network of providers to choose from.
Give Us a Call Today!
Medicare With Jake brings you great coverage right from our office in Wichita, Kansas. We’re here to walk you through all your Medicare options so you can find a plan that fits your needs. To learn more about your options with Medicare Advantage, give us a call today!
