What Are The Different Medicare Benefit Plans?
Medicare Advantage plans are health insurance options for people with Medicare. This includes Medicare-managed care plans, such as Medicare Health Maintenance Organizations (HMO) and Preferred Provider Organizations (OPP). The most recent option is the Private Service Rate Plans (PFFS). Each year, Medicare staff can choose from the Medicare Advantage Plan options available in their area. Regardless of the Medicare benefit plan that a person chooses for coverage, they will continue to pay the Part B premium. It is important to understand how the different Medicare benefit plans work. The descriptions below will provide a brief description of these plans. These options vary by state and county in their availability.
Health Maintenance Organizations (HMOs): Medicare HMOs offer services through a network of hospitals, doctors and other service providers. People with Medicare who choose to participate in an HMO must receive all of their non-emergency Medicare services from the HMO provider network. In general, health plans have small copies for covered medical services. The HMO often uses the primary care physician as a “janitor” to control medical costs and requires referrals to specialized medical services.
Preferred Provider Organizations (OPP): Medicare PPO is similar to an HMO in the sense that PPO has a network of medical providers contracted with the insurance company to provide medical services to people eligible for Medicare. However, PPOs generally do not require the referral of primary care physicians to specialized medical services.
Similar to the action plan, the PPO has health care records received from providers in the PPO network. However, the PPO generally has higher out-of-pocket expenses for medical services received outside the network of medical providers.
Private Service Charge (PFFS): Private companies offer Medicare PFF plans to provide health care coverage to people with Medicare with a service payment contract. Insurance companies may decide that a plan will be available to all people with Medicare in one state or open only in certain municipalities. In addition, the PFFS plan may also offer additional health benefits. This may include prescription drug benefits, vision, hearing, wellness programs, etc.
With a PFFS plan, you can go to any Medicare advantage -approved doctor or hospital that is willing to help and accept your plan’s payment terms and can get services outside of your service area, but at a higher cost. You The insurance company, instead of the Medicare program, decides how much you pay for the services you receive. Although the amount you pay for these services may not be the same as your original Medicare plan, you get all the services covered by Part A and Part B.