You Can Choose From 4 Typical Medicare Advantage Plans

You Can Choose From 4 Typical Medicare Advantage Plans

 You Can Choose From 4 Typical Medicare Advantage Plans

If you choose to enroll in a Medicare Advantage Plan, you must find a doctor who accepts the plan. Although it appears to be complex, it is not. Keep in mind that while not all Medicare Advantage plans require you to use a network-approved provider, many of them do. You may be charged a higher copayment or coinsurance if you choose an out-of-network physician.

You should review your plan's literature to learn about the coverage rules and whether you are required to use providers who participate in your Medicare Advantage plan. What types of Medicare Advantage plans are available, and do they limit you to providers in the plan's network?

  • HMOs (Health Maintenance Organizations) – HMOs (Health Maintenance Organizations) are a type of health-care organization This is a highly rated Medicare Advantage plan, with costs that are often lower than those of other types. One disadvantage is that you must choose a primary care provider from inside their network. Prescription medicines will be covered by the majority of these policies.
  • HMO-POS (Health Maintenance Organization Point of Service) – These plans have a provider network, and seeing a doctor who is not in the network will cost you more. Medications prescribed by a doctor are usually covered.
  • PPOs (Preferred Provider Organizations) - Using the approved network doctors may save you money. You can seek medical treatment outside of your plan's network, but the costs will be higher - copayments and coinsurance will be higher. You usually don't have to choose a primary care provider, and most insurance plans cover prescription drug expenditures.
  • PFFS (Provider Fee-for-Service) — These plans decide how much to pay Medicare providers and enrollees. You can come across doctors who accept Medicare assignments and agree to the provisions of the PFFS plan. Prescription medication may or may not be covered under PFFS insurance.

Other Medicare Advantage plans exist, some of which require you to see a doctor who is part of their provider network.

People have a lot of questions about Medicare Advantage Plans

  • Is it possible for me to use my doctors at any hospital or facility? Are they connected to the network?
  • Will the doctors/providers I want to see accept new patients under the plan?
  • Will the plan cover any out-of-network providers?
  • What hospitals, specialists, skilled nursing facilities, and other services are available through the network?
  • What is the service area of the plan?
  • Will care be covered if it is received outside of the coverage area?
  • Is it possible for me to select my own primary care physician?
  • Will the plan require prior authorization for hospitalization?
  • Will you need a referral to see a PCP?
  • What kinds of charges, like as deductibles, premiums, and copayments, will I be responsible for?
  • Is there a limit out-of-pocket expense every year?
  • Will the plan cover outpatient prescription medications?
  • Are there any limitations to my plan's coverage?
  • Is it possible for me to go to whatever drugstore I want?
  • Will my prescription meds be covered if I travel?
  • What will I spend for brand-name and generic drugs?
  • Will my plan be compatible with the coverage I now have?
  • If I join the plan, would I lose my retiree or job-based coverage insurance?

How to Find a Physician Who Accepts Medicare Advantage Plans

There are a few options for finding a doctor who participates in your Medicare Advantage plan, including:
  • To discover those doctors, go to your plan's website or call customer support.
  • To find out if your Medicare Advantage plan is approved, call the doctor's office. You can also examine if the doctor is listed on the plan's website.
  • To find doctors who accept your plan, use the Find Medicare Doctors Tool.
Out-of-network providers are not required to treat PPO plan participants unless it is an emergency. It's a good idea to call ahead to acquire a pre-service organization determination before seeing an out-of-network doctor or service. To learn more about out-of-network services, contact your plan's customer service or consult the Evidence of Coverage.