One of the main benefits of acquiring a Medicare Advantage plan is that you have options. Unlike Original Medicare, which provides the same benefits for everyone, Medicare Advantage has various plans to meet the needs of different people. However, this also raises a lot of questions and causes confusion for older adults who don’t know which plan is best for them. So, today we are going to provide a simple breakdown of some of the most popular Medicare Advantage plans.
Health Maintenance Organization (HMO) plans provide the same coverage as Medicare Part A and B. Additionally, most HMO plans provide Part D prescription drug coverage. HMO plans are unique because they require you to get most of your care within a select network of doctors and facilities. When you receive in-network care, the cost will be lower and your HMO will cover the cost. However, HMO plans generally allow you to seek out-of-network care for emergency medical treatment.
Preferred Provider Organization (PPO) plans are similar to HMO plans, however, they provide greater coverage for out-of-network care. In fact, while most HMO plans provide minimal coverage for out-of-network care, PPO plans are designed to provide maximum coverage for all care, regardless of your network. However, you can expect to pay higher copays for services like inpatient care and Durable Medical Equipment (DME).
Private Fee-for-Service (PFFS) plans are highly unique, as each plan determines how much you will pay for certain services. Some PFFS plans have networks in which you can seek low-cost care, while others do not. Similarly, some PFFS plans include prescription drug coverage, while others do not. You will need to read the fine print and ensure that a PFFS plan is right for you before signing up.
Like all Medicare Advantage plans, Special Needs Plans (SNP) cover all the same services as Original Medicare. Additionally, SNPs are designed for people who have disabilities or other kinds of “special needs.” For example, many SNPs will cover additional days in the hospital for inpatient care. However, not everyone is eligible for SNP. You will need to meet certain requirements set out by Medicare to sign up.
An HMO Point-of-Service (HMO-POS) plan is like a combination of HMO and PPO. HMO-POS covers all the same services as a traditional HMO, but it gives you greater flexibility to seek some kinds of out-of-network treatment. Most HMO-POS plans also cover prescription drugs.
While people who do not qualify for Medicare can get a Medical Savings Account (MSA), there are special MSA plans designed for Medicare beneficiaries. In essence, these plans are composed of two parts: a high-deductible Medicare plan and a healthcare savings account. Your Medicare plan will deposit funds into your MSA, which can then be used until you meet your annual deductible.
One of the most confusing elements of Medicare Advantage is all the acronyms! Fortunately, these plans are not as complicated as they seem at first glance. Moreover, the flexibility to choose between different plans gives you the ability to find the best plan for you.