Medicare
Advantage Plans
are health plan
options that are
part of the Medicare
program. If you
join one of these
plans, you generally
get all your Medicare-covered
health care through
that plan. This
coverage can include
prescription drug
coverage. Medicare
Advantage Plans
include:
HMO's -
Medicare Health
Maintenance
Organizations
are contracted
with the federal
government under
the Medicare
Advantage program
(formerly called
Medicare+ Choice)
to provide health
benefits to
persons eligible
for Medicare
that choose
to enroll in
the HMO, instead
of receiving
their benefits
and care through
the traditional
fee for service
Medicare program.
PPO's -Medicare
Preferred Providers
Associations.
With a Medicare
Advantage PPO,
you are able
to see any doctor
you want, however,
if you use a
doctor who participates
in the network,
you get a better
benefit and
lower co-payment
than if you
visit a non-network
doctor. Referrals
aren't needed
and you are
not required
to see a primary
care doctor
first. In addition
to prescription
drug benefits,
Medicare Advantage
PPOs may offer
additional benefits
such as dental,
vision, and
nutritional
supplements.
If you select
a Medicare Advantage
PPO, it replaces
your Original
Medicare coverage.
However, you
can return to
Original Medicare
down the road
if you wish.
PSO's -Provider
Sponsored Organizations-Like
HMO's except
they are formed
by a group of
hospitals and
doctors who
directly take
on the financial
risk of providing
comprehensive
health care
coverage for
Medicare beneficiaries.
There is no
insurance company
involved.
PFFS -
Medicare Private
fee for service
plans. With
a Medicare Advantage
PFFS plan, you
have the freedom
to select any
doctor, hospital,
or health care
provider the
PFFS payment
terms and conditions,
without worrying
about referrals
or a list of
doctors who
participate
in the plan's
network. PFFS
plans feature
limits on out-of-pocket
expenses, coverage
for emergency
and urgent care,
and in some
cases, a prescription
drug benefit.
SNP -Medicare
Special Needs
Plans Medicare
Advantage Coordinated
Care Plan focused
on individuals
with special
needs such as
Institutionalized
beneficiaries
(those who
reside or
is expected
to reside
for 90 days
or longer
in a long
term care
facility or
living in
a community
but is requiring
an equivalent
level of care
as those living
in a long
term care
facility.
Dually eligible
beneficiaries
(entitled
to a state
medical assistance).
Beneficiaries
with chronic
conditions.
*Note: Medicare Advantage Plans do not work with Medigap policies.
You must have Medicare
Part A and Part
B to join a
Medicare Advantage
Plan. You will still
have to pay your
monthly Medicare
Part B premium
to Medicare and
you may pay a monthly
premium to your
Medicare Advantage
Plan for the extra
benefits such as
dental, vision,
and or chiropractic
services.