2010 Medicare Advantage Plan options
When choosing a Medicare Advantage plan, it’s important to understand the different types of plans available and understand the plans rules before joining. Not all plan types may be available in your area. What’s right for one person, may not be right for you.
Private Fee-for-Service (PFFS) Plans.
Medical Savings Account (MSA) Plans.
Special Needs Plans (SNP).
All Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually co-payments but can also be coinsurance and deductibles.
Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage, sometimes at an extra cost.
PPO Plans
These plans are popular because using the plan is fairly predictable. PPOs have network doctors and hospitals, but you can also use out-of-network providers for covered services, usually at a higher cost. You do not have to choose a specific provider and referrals are not required. PPOs are available either with Part D prescription coverage included or without Part D included.
Choosing a PPO may be right for you if you find the network adequate, but you would still like the flexibility to change providers or go outside of the network for covered services.
HMO Plans
Many choose this type of plan because cost sharing is often more favorable. HMOs generally require that you get your care and services from doctors and hospitals that are in network. Exceptions to this would be emergency care or out-of-network urgent care and dialysis services. Some plans offer a point of service that allows you to go out of network for a higher cost. Part D is generally included and choosing a doctor and getting referrals are often required, with the exception of some preventative testing.
In many major metropolitan areas a HMO may be your best choice, as networks are often inclusive and cost sharing generally low. On the other hand, if you travel extensively or live in a rural area where the network is smaller, you may want to choose a PPO.
PFFS Plans
On the surface, PFFS plans offer a great amount of freedom, but getting covered services can often be unpredictable. You are not required to use a network and can choose your own providers, but the plan decides how much they will pay doctors and hospitals and how much you will pay for services. This said, you can go to any Medicare approved doctor or hospital if they agree to treat you. Not all providers will accept the plan’s payment terms or agree to treat you. In fact, they can decide to treat you on a visit by visit basis, except in the case of an emergency.
In some rural areas, PFFS plans may be your only choice (though this is scheduled to change in 2011) because credible networks are difficult to put together by Advantage Plan carriers. Because of legislation to be effective in 2011, many carriers have ceased to offer PFFS plans in certain areas.
MSA Plans
Not as popular as other Advantage Plans, MSA Plans have two parts; a high deductible and a bank account. Medicare gives the plan a sum of money and a portion is deposited into the bank account. Because the sum is usually less than your deductible, you will have out-of-pocket costs until you reach your deductible. Money spent for covered services counts toward your deductible and once the deductible is met, the plan pays for your covered services for that year. Unused funds in your bank account roll over to the following year. MSA Plans do not include drug coverage and a stand alone plan will need to be purchased. You do not need a referral and can choose your own providers.
Choose a MSA Plan if you are extremely healthy and can cover the out-of-pocket expenses.
SNP Plans
Membership in these plans is generally limited to specific groups of people. A SNP may be right for you if you; eligible for both Medicare and Medicaid (dual enrolled), or you are a resident of certain types of institutions, (such as a nursing home), require nursing care at home or if you have one or more specific chronic health conditions such as congestive heart failure, diabetes, HIV/Aids, among others). Part D is always included and you generally need a referral and must use the providers in network except for emergency care and certain preventative services.
Consider a SNP if you meet the criteria for enrollment, as these plans are designed to best meet your needs.Armed with knowledge you can choose wisely
Summing it all up
Understanding the different types of plans available, and how they relate to your circumstances can go a long way towards a fulfilling experience in your Advantage Plan membership and usage
